title: Lack of association between pretreatment neurology consultation and subsequent protocol deviation in tissue plasminogen activator-treated patients with stroke.
abstract: OBJECTIVE
  We evaluated the hypothesis that consultation with neurology would be associated with fewer protocol deviations in tissue plasminogen activator-treated patients with stroke.
  
  
  METHODS
  A retrospective analysis of consecutive tissue plasminogen activator-treated patients with acute patients was performed. Using chi(2) tests, the proportion of patients with a protocol deviation was calculated and compared between those with evidence of a neurology consultation and those without. Logistic regression was then used to determine the OR for protocol deviation at the same time as controlling for clinical presentation covariates.
  
  
  RESULTS
  Two hundred seventy-three subjects were included. Protocol deviation rates did not significantly differ between those with (44%) and those without (41%) a consultation. The adjusted OR for deviation comparing any consultation versus nonconsultation was 1.25 (95% CI: 0.58 to 2.68). There was no statistically significant difference between symptomatic intracranial hemorrhage and in-hospital mortality rates between the groups. The proportion of patients with pretreatment deviations not related to timing was low in both the consultation (9.7%) and nonconsultation groups (8.1%).
  
  
  CONCLUSIONS
  Neurological consultation was not found to be associated with decreased protocol deviations in this cohort, although the high proportion of deviations with and without consultation suggests that quality improvement is needed. Most observed pretreatment deviations were attributable to timing. As acute stroke care becomes more efficient and additional methods in reducing door-to-treatment times are sought, models in which emergency physicians direct the initial phase of treatment may merit further consideration.
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, Mich, USA. wmeuer@umich.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Meurer
authors.forename: Angela F
authors.initials: AF
authors.lastname: Caveney
authors.forename: Alex
authors.initials: A
authors.lastname: Lo
authors.forename: Lingling
authors.initials: L
authors.lastname: Zhang
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Frederiksen
authors.forename: Annette M
authors.initials: AM
authors.lastname: Sandretto
authors.forename: Robert
authors.initials: R
authors.lastname: Silbergleit
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Scott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator