title: Large numbers of stroke physicians should be used to treat large numbers of stroke patients with IV rt-PA.
abstract: OBJECTIVE
  Our aim was to investigate the relationship between number of stroke physicians (SPs) and number of patients treated with intravenous thrombolysis (IV rt-PA) per year.
  
  
  METHODS
  Questionnaires about the infrastructure of acute stroke care including number of SPs and patients given IV rt-PA from October 2008 to September 2009 were sent to 3877 hospitals in Japan. We compared the number of SPs between: 1) hospitals not giving IV rt-PA for a year vs. hospitals giving IV rt-PA for ≥ 1 patient; 2) ≤ 5 vs. >5 patients; 3) ≤ 10 vs. >10 patients; and 4) ≤ 25 vs. >25 patients. We established cut-off numbers of SPs administering IV rt-PA for ≥ 1, >5, >10, and >25 patients/hospital/year using a sensitivity-specificity curve.
  
  
  RESULTS
  Responses were received from 2488 of the 3877 hospitals (64.2%), and 919 hospitals admitted acute stroke patients. Of these, 385 hospitals were not administering IV rt-PA in that year, 250 hospitals gave IV rt-PA for 1-4 patients, 131 hospitals for 5-9 patients, 102 hospitals for 10-25 patients, and 30 hospitals for >25 patients. Cut-off numbers of SPs per hospital were 1 doctor administering IV rt-PA for ≥ 1 patient/year (sensitivity, 83.8%; specificity, 84.5%), 2 doctors for >5 patients (sensitivity, 85.9%; specificity, 74.1%), 3 doctors for >10 patients (sensitivity, 76.3%; specificity, 75.5%), and 4 doctors for >25 patients (sensitivity, 86.2%; specificity, 78.5%). An independent factor for IV rt-PA with >25 patients was ≥ 4 SPs (odds ratio, 3.83; 95% confidence interval, 1.17-12.63; p=0.027).
  
  
  CONCLUSIONS
  Higher numbers of SPs should be associated with higher numbers of patients getting IV rt-PA.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 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
mesh_terms: D004363:Drug Utilization; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D010820:Physicians; D010960:Plasminogen Activators / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator