title: Prehospital transfer medicalization increases thrombolysis rate in acute ischemic stroke. A French stroke unit experience.
abstract: OBJECTIVE
  Narrow therapeutic window is a major cause of thrombolysis exclusion in acute ischemic stroke. Whether prehospital medicalization increases t-PA treatment rate is investigated in the present study.
  
  
  METHODS
  Intrahospital processing times and t-PA treatment were analyzed in stroke patients calling within 6h and admitted in our stoke unit. Patients transferred by our mobile medical team (SAMU) and by Fire Department (FD) paramedics were compared.
  
  
  RESULTS
  193 (61.6%) SAMU patients and 120 (38.4%) FD patients were included within 30 months. Clinical characteristics and onset-to-call intervals were similar in the two groups. Mean door-to-imaging delay was deeply reduced in the SAMU group (52 vs. 159 min, p<0.0001) and was <25 min in 50% of SAMU patients and 14% of FD patients (p<0.0001). SAMU management was the only independent factor of early imaging (p=0.0006). t-PA administration rate was higher in SAMU group than in FD group (42% vs. 28%, p=0.04). Proportion of patients with delayed therapeutic window was higher in FD group than in SAMU group (38% vs. 26%, p<0.0001).
  
  
  CONCLUSIONS
  Prehospital transfer medicalization promotes emergency room bypass, direct radiology room admission and high thrombolysis rate in acute ischemic stroke.
authors.affiliation: Neurology and Stroke Center, University Hospital of Fort-de-France, Martinique. julien_joux@hotmail.com
authors.forename: Julien
authors.initials: J
authors.lastname: Joux
authors.forename: Stéphane
authors.initials: S
authors.lastname: Olindo
authors.forename: Annette
authors.initials: A
authors.lastname: Girard-Claudon
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chausson
authors.forename: Martine
authors.initials: M
authors.lastname: Saint-Vil
authors.forename: Aissatou
authors.initials: A
authors.lastname: Signate
authors.forename: Mireille
authors.initials: M
authors.lastname: Edimonana
authors.forename: Severine
authors.initials: S
authors.lastname: Jeannin
authors.forename: Mathieu
authors.initials: M
authors.lastname: Aveillan
authors.forename: Philippe
authors.initials: P
authors.lastname: Cabre
authors.forename: Didier
authors.initials: D
authors.lastname: Smadja
mesh_terms: D000368:Aged; D000552:Ambulances; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005602:France; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D062528:Medicalization; D008875:Middle Aged; D008952:Mobile Health Units; D010348:Patient Care Team; D010360:Patient Transfer / Q000379:methods*; D010820:Physicians; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Ambulance; Medicalization; Prehospital; Stroke; Thrombolysis