title: Variability in the use of intravenous thrombolysis for mild stroke: experience across the SPOTRIAS network.
abstract: BACKGROUND
  Current guidelines do not define the lower severity threshold for thrombolysis. In this study, we describe the variability of treatment of mild stroke patients across a network of academic stroke centers.
  
  
  METHODS
  Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collect data on patients treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), including demographics, pretreatment National Institutes of Health Stroke Scale (NIHSS) scores, and in-hospital mortality. We examined the variability in proportion of total tissue plasminogen activator-treated patients in the NIHSS categories (0-3, 4-5, or ≥ 6) and associated outcomes.
  
  
  RESULTS
  A total of 2514 patients with reported NIHSS scores were treated with IV rt-PA between January 1, 2005 and December 31, 2009. The proportion of patients with mild stroke (NIHSS scores of 0-3) who were treated with IV rt-PA varied substantially across the centers (2.7-18.0%; P < .001). There were 5 deaths in the 256 treated with an NIHSS score of 0-3 (2.0%). The proportion of treated patients across the network with an NIHSS score of 0 to 3 increased from 4.8% in 2005 to 10.7% in 2009 (P = .001).
  
  
  CONCLUSIONS
  There is substantial variability in the proportion of treated patients who have mild stroke across the SPOTRIAS centers, reflecting a paucity of data on how to best treat patients with mild stroke. Randomized trial data for this group of patients are needed to clarify the use of rt-PA in patients with the mildest strokes.
authors.affiliation: Department of Neurology, Columbia University, New York, New York, USA. jzw2@columbia.edu
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Willey
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.forename: Jane C
authors.initials: JC
authors.lastname: Khoury
authors.forename: José G
authors.initials: JG
authors.lastname: Merino
authors.forename: Andria L
authors.initials: AL
authors.lastname: Ford
authors.forename: Natalia S
authors.initials: NS
authors.lastname: Rost
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Gonzales
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.forename: Brett C
authors.initials: BC
authors.lastname: Meyer
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
mesh_terms: D000046:Academic Medical Centers; D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011994:Recombinant Proteins / Q000008:administration & dosage; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator