title: Increasing number of stroke specialists should contribute to utilization of IV rt-PA: results of questionnaires from 1,466 hospitals in Japan.
abstract: OBJECTIVE
  To determine the present status of intravenous recombinant tissue plasminogen activator (IV rt-PA) administration in Japan, we investigated the components of stroke case related to IV rt-PA utilization using a questionnaire sent to hospitals.
  
  
  METHODS
  Questionnaires about the infrastructure of acute stroke care were sent to 8,589 hospitals between August and October 2007. Responses were categorized as follows: 1) stroke service run by stroke physicians (SPs) 24 h/day, 7 days/week (24/7); 2) IV rt-PA utilizable 24/7 (rt-PA hospitals); 3) the total number of SPs. The components related to rt-PA hospitals were analyzed and the significance of the number in SPs to the rt-PA hospital was investigated.
  
  
  RESULTS
  Responses were received from 4,690 (54.7%) of 8,569 hospitals. Of these, 1,466 hospitals were admitting acute stroke patients. 519 of those hospitals were rt-PA hospitals. Of the 1,466 (35.4%), 48.4% were serviced 24/7 by SPs, with 75.2% having <5 SPs. Multivariate analysis revealed administration of rt-PA was significantly associated with >4 SPs (odds ratios (OR), 2.8; 95% confidence interval (95%CI), 1.9-4.1; p<0.001). Compared to hospitals with 0-1 SPs as a reference, the OR for rt-PA utilization was 5.6 (95%CI, 2.5-12.9; p<0.001) with 5 SPs, 10.8 (95%CI, 5.0-23.6; p<0.001) with 6-10 SPs, and 37.3 (95%CI, 6.5-213.1; p<0.001) with >10 SPs.
  
  
  CONCLUSIONS
  An increased number of SPs was associated with increased IV rt-PA utilization. Development of stroke centers with larger numbers of SPs is therefore urgently needed.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Okayama, Japan. yigu@med.kawasaki-m.ac.jp
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Iguchi
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwanaga
mesh_terms: D016001:Confidence Intervals; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019538:Health Care Surveys; D006761:Hospitals; D006801:Humans; D007262:Infusions, Intravenous; D007564:Japan; D016015:Logistic Models; D015999:Multivariate Analysis; D009462:Neurology; D016017:Odds Ratio; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013038:Specialization; D020521:Stroke / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000096:biosynthesis / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator