title: [Provincial stroke code: characteristics and impact on health care].
abstract: BACKGROUND
  Endovenous thrombolysis is the preferred treatment in the early hours following cerebral infarction and delays are the main obstacle preventing it from being used on a more widespread basis. The stroke code (SC) is a system that allows stroke patients to be identified quickly and taken to the most suitable hospital for such treatment to be implemented. AIM. To determine the impact of extending the intra-hospital SC (ISC) to a provincial SC (PSC).
  
  
  METHODS
  The system consists in a prospective register of cases of SC treated in a provincial stroke centre. Data on the cases of cerebral infarction admitted consecutively the year prior to and after beginning the PSC (1st November 2008) were collected.
  
  
  RESULTS
  In one year 318 SC were handled: 61.2% were extra-hospital SC (ESC). A total of 45 patients were thrombolysed: 14.2% of the activations and 25.7% of cerebral infarctions with the code activated. The gross annual rate of thrombolysis was 7.7/100,000 inhabitants (95% confidence interval, 95% CI = 5.7-10.4). Primary medicine activated 34% of the codes. There are no significant differences between ESC and ISC as regards the percentage of correct activations and thrombolysis. The door-to-needle delay is shorter in ESC (59.7 ± 24 versus 74.4 ± 20 minutes; p = 0.012). The time slot from 22 pm to 8 am covers 23.6% of the SC and 22.2% of cases of thrombolysed patients. From the first to the second period, SC activation rises from 11.1% to 37.9% of cerebral infarctions and thrombolysis increases from 3.8 to 12.7% (p < 0.0001; odds ratio = 4.1; 95% CI = 1.9-8.6).
  
  
  CONCLUSIONS
  The PSC allowed thrombolysis of cerebral infarction to be carried out in four times as many cases, as well as improving the health care chain and extending it throughout the whole province.
authors.affiliation: Sección de Neurología y Unidad de Ictus, Hospital General de Castellón, Castellón, España. dgeffners@yahoo.es
authors.forename: Daniel
authors.initials: D
authors.lastname: Geffner-Sclarsky
authors.forename: Cristina
authors.initials: C
authors.lastname: Soriano-Soriano
authors.forename: Carlos
authors.initials: C
authors.lastname: Vilar
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Vilar-Ventura
authors.forename: Antonio
authors.initials: A
authors.lastname: Belenguer-Benavides
authors.forename: Berta
authors.initials: B
authors.lastname: Claramonte
authors.forename: Marisol
authors.initials: M
authors.lastname: Campillo
authors.forename: Ana
authors.initials: A
authors.lastname: del Villar
authors.forename: Elena
authors.initials: E
authors.lastname: Pajarón-Boix
authors.forename: Manuel
authors.initials: M
authors.lastname: Peinazo-Arias
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy; D003695:Delivery of Health Care; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D014187:Transportation of Patients