title: Thrombolysis rate and impact of a stroke code: a French hospital experience and a systematic review.
abstract: BACKGROUND
  Intravenous rt-PA is effective in hyperacute ischemic stroke (HAIS) but is administered only in few patients.
  
  
  OBJECTIVE
  To report the thrombolysis rate in our stroke unit using a stroke code (SC) protocol with a prenotification system and to analyze the SC impact on the thrombolysis rate in a systematic review.
  
  
  METHODS
  We report, from 2005 to 2009, the intravenous rt-PA rate in our prospective registry of hyperacute strokes suspicions. The systematic review was conducted in searching PubMed and EMBASE for prospective studies reporting thrombolysis rates and their use of a SC. We categorized SC between those with a prenotification by the Emergency Medical Services and those with only an in-hospital SC system.
  
  
  RESULTS
  Among the 1450 stroke patients hospitalized in our stroke unit, 349 were admitted via the SC protocol as suspicions of hyperacute strokes. Intravenous rt-PA rates were: 12.9% of the ischemic strokes, 36% of the suspicions of hyperacute strokes and 59.6% of the HAIS. We found 23 studies reporting thrombolysis rates ranging from 10.3% to 58% of HAIS. Ten studies gave data concerning the use of a SC in case of HAIS. Thrombolysis rate was higher in hospitals with a prenotification system (54.7%) compared with both those with no specific organization (18.2%) (OR=5.43, 95% CI: 3.84-7.73) and those with an in-hospital restricted SC (37.9%) (OR=1.97, 95% CI: 1.53-2.54).
  
  
  CONCLUSIONS
  Thrombolysis rate of HAIS is improved by a SC, especially when a prenotification system of thrombolysis candidates by Emergency Medical Services to the stroke unit is used.
authors: Department of Neurology, Tenon University Hospital, AP-HP, F-75020, Paris, France.
authors: M A
authors: MA
authors: Dalloz
authors: L
authors: L
authors: Bottin
authors: I P
authors: IP
authors: Muresan
authors: P
authors: P
authors: Favrole
authors: S
authors: S
authors: Foulon
authors: P
authors: P
authors: Levy
authors: T
authors: T
authors: Drouet
authors: B
authors: B
authors: Marro
authors: S
authors: S
authors: Alamowitch
mesh_terms: D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy; D002985:Clinical Protocols; D004363:Drug Utilization; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D010348:Patient Care Team; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator