title: Stroke thrombolysis in the emergency department as an alternative service for community hospitals lacking a stroke unit.
abstract: OBJECTIVE
  A significant advancement in the management of acute ischemic stroke has been the use of the recombinant tissue plasminogen activator (rtPA). French guidelines recommend that stroke patients should be treated in stroke units (SU); however, community hospitals experience practical difficulties in treating their patients because SUs are not sufficient in number. Only one SU is available in the Aquitaine area (southwest of France) and it is located in Bordeaux. To improve quality of care and to provide modern stroke therapy, we decided to assess whether thrombolysis was feasible in our community hospital located in Pau, 200 km from Bordeaux.
  
  
  METHODS
  Selected patients were treated with rtPA and observed for 24 h in the emergency department. According to French legislation, rtPA therapy was defined as 'off-label use'. National Institutes of Health stroke scale (NIHSS) was obtained on admission, immediately after treatment and 24 h after treatment.
  
  
  RESULTS
  Results from the first 40 patients are reported in this study. They were treated between September 2004 and June 2006. In total, 1169 patients were admitted for stroke during this period. Outcomes and mortality rates were consistent with experience elsewhere.
  
  
  CONCLUSIONS
  According to the local infrastructural criteria and prerequisites described in this study, thrombolysis is a viable and feasible treatment option for stroke patients in emergency departments of French community hospitals. In the absence of an SU, this type of emergency treatment can be used as an alternative until SUs become more numerous throughout the country.
authors.affiliation: Department of aNeurology, Hôpital François Mitterrand, Pau, France. bruno.barroso@ch-pau.fr
authors.forename: Bruno
authors.initials: B
authors.lastname: Barroso
authors.forename: Christophe
authors.initials: C
authors.lastname: Morisset
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Larrieu
authors.forename: Eric
authors.initials: E
authors.lastname: Bertandeau
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dakar
authors.forename: Hervé
authors.initials: H
authors.lastname: Mangon
authors.forename: François
authors.initials: F
authors.lastname: Rouanet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005602:France; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D018579:Patient Selection; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator