Stroke center characteristics which influence the administration of thrombolytic therapy for acute ischemic stroke: a national survey of stroke centers in Taiwan.
Stroke centers and intravenous tissue plasminogen activators (tPA) are effective management for acute ischemic stroke. This study aimed to analyze stroke center characteristics on the administration of thrombolytic therapy. A national survey of stroke centers in academic medical centers and regional teaching hospitals in Taiwan was conducted. The survey questions included the number of tPA or other thrombolytic therapies, presence of stroke intensive care units and wards, initiation of rehabilitation, and 15 criteria for establishment of stroke centers adopted from the Brain Attack Coalition's recommendation. Factors influencing administration of thrombolytic therapy were analyzed. Intravenous tPA increased from 135 cases in 2004 to 246 cases in 2006, accounting for approximately 0.4% and 0.8% of all acute ischemic stroke patients in Taiwan, respectively. The frequency of thrombolytic therapy administration significantly correlated with stroke center criteria (Spearman's rho=0.731, P<0.001). Multivariate analysis showed routine intravenous tPA protocol in the emergency room (odds ratio=4.6, P=0.042) and supervision by the stroke center director (odds ratio=3.7, P=0.031) significantly influenced the administration of thrombolytic therapy. Well-organized stroke centers, routine use of thrombolytic therapy protocols in the emergency room, and guidance by a stroke center director are important for enhancing thrombolytic therapy in patients with acute ischemic stroke.
Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
Jiann-Shing
JS
Jeng
Sung-Chun
SC
Tang
I-Chan
IC
Deng
Li-Kai
LK
Tsai
Shin-Joe
SJ
Yeh
Ping-Keung
PK
Yip
D002545:Brain Ischemia / Q000188:drug therapy* / Q000534:rehabilitation; D004636:Emergency Service, Hospital; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006757:Hospital Units; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D016014:Linear Models; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000188:drug therapy*; D000071939:Stroke Rehabilitation; D013624:Taiwan; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator