title: A population-based study of thrombolysis for acute stroke in South Australia.
abstract: OBJECTIVE
  To report the rate of thrombolysis for treating acute stroke in South Australia from October 2007 to September 2009. We hypothesised that the rate of thrombolytic therapy would be related to distance from an acute stroke unit.
  
  
  METHODS
  An observational, population-based, retrospective review of case notes and imaging, using multiple case-ascertainment methods. Patients administered a thrombolytic agent by any method for suspected ischaemic stroke in urban, rural, public and private hospitals in SA (covering a population of 1.5 million people) were included.
  
  
  METHODS
  Absolute and relative contraindications for thrombolysis administration in each case, according to the 2007 National Stroke Foundation guidelines; incidence of haemorrhage; and population thrombolysis rates according to distance from an acute stroke unit.
  
  
  RESULTS
  A total of 158 cases of thrombolytic therapy for suspected acute ischaemic stroke were identified in 157 patients. Fifteen patients (10%) had symptomatic intracranial haemorrhage, of whom eight (5%) died within 3 months. Seven patients had symptomatic extracranial haemorrhage. Five patients (3%) received thrombolysis despite absolute contraindications. Patients living closer to stroke units were more likely to receive thrombolysis.
  
  
  CONCLUSIONS
  Rates of symptomatic haemorrhage after thrombolysis were similar to those in voluntary registries. A large proportion of South Australians are currently missing out on acute stroke therapy as a result of poor access to acute stroke units in both urban and rural settings. It is estimated that fewer than 2% of ischaemic stroke patients are administered thrombolysis in SA.
authors.affiliation: Queen Elizabeth Hospital, Adelaide, SA, Australia. james.leyden@health.sa.gov.au
authors.forename: James M
authors.initials: JM
authors.lastname: Leyden
authors.forename: Woon K
authors.initials: WK
authors.lastname: Chong
authors.forename: Tim
authors.initials: T
authors.lastname: Kleinig
authors.forename: Andrew
authors.initials: A
authors.lastname: Lee
authors.forename: John B
authors.initials: JB
authors.lastname: Field
authors.forename: Jim
authors.initials: J
authors.lastname: Jannes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019035:Rural Health Services; D013021:South Australia; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D019037:Urban Health Services