title: An alternative facility for a stroke unit in a community hospital.
abstract: OBJECTIVE
  The administration of tissue plasminogen activator (tPA) to patients with acute ischemic stroke (AIS) within three hours from onset of neurological symptoms is presently accepted as the standard treatment for suitable individuals, since it has been shown that it improves their outcome. The aim of this retrospective study was to report our experience with tPA administration in a subunit of a department of internal medicine adapted specifically for that goal.
  
  
  METHODS
  The study was carried out in a subunit of a department of internal medicine. This subunit was equipped with all necessary items for monitoring vital signs. The patients received 0.9mg/kg of tPA intravenously and remained under around-the-clock supervision by highly trained nurses.
  
  
  METHODS
  Thirty one patients (11 women and 20 men), diagnosed with AIS between 2004 and 2008, and eligible for tPA treatment, were included in the study.
  
  
  RESULTS
  The interval from the onset of stroke to tPA administration (onset to treat time OTT) was 145±2.2min, whereas the interval from door-to-needle was 100±4min. Two patients (6.4%) died during hospitalization because of severe intracerebral hemorrhage. Three patients with hemiparesis (9.6%) developed minor hemorrhages detected by brain CT. The mean length of stay was 8.8±0.6days.
  
  
  CONCLUSIONS
  Our results are comparable with those obtained in stroke units in other countries. The suggested model offers a possibility for appropriate and rapid thrombolysis for AIS in a community hospital lacking special stroke unit. Moreover, the suggested alternative does not require extensive economic investment, since there is no need for additional staff, and permits the use of already existing hospital facilities.
authors.affiliation: Department of Internal Medicine “C”, Rabin Medical Center, Hasharon Hospital, Petah-Tiqva, Israel. dc375380@netvision.net.il
authors.forename: Michael
authors.initials: M
authors.lastname: Bergman
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Ori
authors.forename: Naava
authors.initials: N
authors.lastname: Blumberger
authors.forename: Hertzel
authors.initials: H
authors.lastname: Salman
mesh_terms: D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000600:supply & distribution*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007557:Israel; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods