Telephonic guidance of systemic thrombolysis in acute ischemic stroke: safety outcome in rural hospitals.
OBJECTIVE
To determine the safety of telephonic guidance for use of intravenous recombinant tissue plasminogen activator (IV rtPA) in rural hospitals.


METHODS
We performed a retrospective survey of 123 consecutive patients treated with IV rtPA for acute ischemic stroke (AIS) in rural hospitals between November 2003 and September 2006 and subsequently transferred to a tertiary medical center. Selection for treatment was performed by a stroke neurologist who conducted a structured telephone interview of the requesting physician. Primary outcome measures included symptomatic intracerebral hemorrhage (ICH) and in-hospital mortality.


RESULTS
Elapsed time (ET) from stroke onset to community hospital arrival was 54+/-30 min. ET from stroke onset to tPA bolus was 133+/-37 min. Three patients (2.5%) had symptomatic ICH, 11 (9%) had asymptomatic ICH, 9 patients (7.5%) died. Mean length of stay was 4+/-3 days; 47% were discharged to their homes. Mean ET from stroke onset to rtPA dosage did not differ significantly from the active treatment group of the NINDS rtPA Stroke Study. Prevalence of symptomatic ICH and mortality were lower in our population.


CONCLUSIONS
We conclude that telephonic guidance of rtPA treatment is safe, practical, and effective in overcoming barriers for optimal care of AIS in rural communities.
Vaishnav
Anand G
AG
Stroke Program of the Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536-0230, USA. agvais2@email.uky.edu
Pettigrew
L Creed
LC
Ryan
Stephen
S
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000517:prevention & control; D019058:Community Networks; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006780:Hospitals, Rural; D006801:Humans; D007262:Infusions, Intravenous; D007629:Kentucky; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D019114:Remote Consultation; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator