A regional system of stroke care provides thrombolytic outcomes comparable with the NINDS stroke trial.
OBJECTIVE
Administration of tissue plasminogen activator (tPA) for acute ischemic stroke remains controversial in community practice. Well-organized hierarchic systems of acute stroke care have been proposed to link community hospitals to comprehensive stroke centers. We report safety and functional outcomes in patients treated with tPA in our regional emergency stroke network and compare them with results reported from the trial conducted by the National Institute of Neurological Disorders and Stroke (NINDS).


METHODS
Through a statewide communications and transport network, our brain attack center gives emergency medicine staff in the state and surrounding area immediate access to stroke specialists. The team provides consultation about the administration of tPA for ischemic stroke, using the NINDS protocol. Consultations, treatment, and outcomes are documented in our database.


RESULTS
From 1996 to 2005, the brain attack center completed 2,670 consultations and diagnosed 1,788 patients with ischemic stroke. Two hundred forty patients (9% of all consultations; 13.4% of those with acute ischemic stroke) received tPA. Percentages of patients with symptomatic intracranial hemorrhage and 3-month modified Rankin scale scores less than or equal to 1, compared with those in the NINDS trial, were as follows: 3.3% versus 6.4% and 53% versus 43% (P=.04). Mortality rates were 13% (network) versus 17% (NINDS).


CONCLUSIONS
During a 9-year period, an emergency medicine network with stroke consultants achieved patient outcomes comparable to those reported from the NINDS trial. These results indicate that the NINDS tPA protocol is applicable to community practice, with the support of a university-based brain attack center.
LaMonte
Marian P
MP
Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. mlamonte@stagnes.org
Bahouth
Mona N
MN
Magder
Laurence S
LS
Alcorta
Richard L
RL
Bass
Robert R
RR
Browne
Brian J
BJ
Floccare
Douglas J
DJ
Gaasch
Wade R
WR
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003691:Delaware; D004219:District of Columbia; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010414:Pennsylvania; D015397:Program Evaluation; D020127:Recovery of Function; D012041:Regional Medical Programs / Q000706:statistics & numerical data*; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014903:West Virginia; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator