title: Relevance of prehospital stroke code activation for acute treatment measures in stroke care: a review.
abstract: BACKGROUND
  The use of emergency services with prehospital stroke assessment and early notification to the treatment hospital (stroke code) is a crucial determinant of delay time for acute stroke treatment. We reviewed and summarized the literature on prehospital stroke code system implementation.
  
  
  METHODS
  Two databases were explored (last update June 20, 2011) with 3 key words (stroke code, stroke prehospital management and stroke prehospital services). Inclusion criteria were: randomized and quasirandomized controlled trials, cohort and case-control studies, and hospital- and emergency-based registers, with no year or language restrictions. We examined the reference lists of all included articles. All potentially relevant reports and abstracts were transcribed into a specifically designed data abstraction form.
  
  
  RESULTS
  Only 19 of the 680 studies which were initially retrieved, published from 1999 to 2011, fulfilled our inclusion criteria. One clinical trial was identified. Large differences in stroke code procedures and study designs within and across countries prohibited the pooling of the data. Most studies were carried out in urban areas. Assuming the rate of tissue-plasminogen activator treatment as the performance measure, most studies report a significant increase in the rate of treatment (increase between 3.2 and 16%) with only 1 study not reporting any increase.
  
  
  CONCLUSIONS
  Despite its limitations, this review suggests that the use of prehospital stroke code is an important intervention to improve the accessibility of the benefits of thrombolysis, especially when implemented together with educational campaigns to optimize the awareness and behavior of patients and bystanders.
authors.affiliation: Institute of Neurosciences, Italian National Research Council, University of Florence, Florence, Italy. baldereschi@in.cnr.it
authors.forename: Marzia
authors.initials: M
authors.lastname: Baldereschi
authors.forename: Benedetta
authors.initials: B
authors.lastname: Piccardi
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Carlo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucente
authors.forename: Donata
authors.initials: D
authors.lastname: Guidetti
authors.forename: Domenico
authors.initials: D
authors.lastname: Consoli
authors.forename: Leandro
authors.initials: L
authors.lastname: Provinciali
authors.forename: Danilo
authors.initials: D
authors.lastname: Toni
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Sacchetti
authors.forename: Bianca Maria
authors.initials: BM
authors.lastname: Polizzi
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
mesh_terms: D059019:Clinical Coding; D019468:Disease Management; D004632:Emergency Medical Services / Q000639:trends*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator