A protocol-driven model for the rapid initiation of stroke thrombolysis in the emergency department.
OBJECTIVE
To assess efficacy and safety of a 24-hour comprehensive protocol-driven model for rapid assessment and thrombolysis of stroke patients in the emergency department.


METHODS
Prospective open observational study.


METHODS
All patients with acute stroke presenting within 3 hours to the St Vincent's Hospital (Sydney) emergency department between 1 December 2004 and 30 July 2005.


METHODS
Proportion of patients treated, patient demographics, clinical outcome, adverse events and time to treatment parameters.


RESULTS
134 patients (100 stroke; 34 transient ischaemic attack) were admitted to the stroke unit during the study period. Of the 100 stroke patients, 40 presented within 3 hours of symptom onset. Fifteen patients had no contraindications and received intravenous thrombolysis. At 3 months, 10 patients (67%) were independent (modified Rankin score [mRS], 0-2) and seven (47%) had an excellent functional outcome (mRS < or = 1). Symptomatic intracranial haemorrhage was not observed. The median time from symptom onset to tissue plasminogen activator treatment was 155 minutes (range, 105-197 min). Median onset-to-door, door-to-computed tomography, and door-to-needle times were 48, 25, and 87 minutes, respectively.


CONCLUSIONS
Rapid assessment of stroke in the emergency department according to a comprehensive protocol allows identification and treatment of acute ischaemic stroke patients eligible for thrombolysis.
Batmanian
Julia J
JJ
St Vincent's Hospital, Sydney, NSW, Australia.
Lam
Meeyin
M
Matthews
Caitlin
C
Finckh
Andrew
A
Duffy
Martin
M
Wright
Robert
R
Brew
Bruce J
BJ
Markus
Romesh
R
D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator