title: A protocol-driven model for the rapid initiation of stroke thrombolysis in the emergency department.
abstract: 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.
authors.affiliation: St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Batmanian
authors.forename: Meeyin
authors.initials: M
authors.lastname: Lam
authors.forename: Caitlin
authors.initials: C
authors.lastname: Matthews
authors.forename: Andrew
authors.initials: A
authors.lastname: Finckh
authors.forename: Martin
authors.initials: M
authors.lastname: Duffy
authors.forename: Robert
authors.initials: R
authors.lastname: Wright
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Brew
authors.forename: Romesh
authors.initials: R
authors.lastname: Markus
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator