title: How to improve access to appropriate therapy and outcome of the acute ischemic stroke: a 24-month survey of a specific pre-hospital planning in Northern Italy.
abstract: Few patients with acute cerebral infarction are medicated with thrombolysis as yet. Thus, a specific plan was created in the area of Bergamo in Northern Italy to increase the number of procedures. The plan, started in 2010, consisted of: (1) subdivision of the area of Bergamo into three zones, each one served by a single Stroke-Unit (SU) licensed to thrombolysis; (2) information to population via newspapers and local broadcasting; and (3) teachings both to personnel of Emergency Medical Service and General Practitioners. Here, we have compared the results of the SU of Policlinico San Marco in the years 2008-2009 versus those in the years 2010-2011. During 2008 and 2009, SU admitted 376 acute ischemic strokes, 60 of whom (16 %) within 3 h of the event. Of those patients, 8 (2 %) were treated with thrombolysis. At 3 months of stroke, 61 patients (16 %) were alive and self-independent. During 2010 and 2011, SU admitted 401 acute ischemic strokes, 91 of whom (22 %) within 3 h of stroke. Of those patients, 23 (6 %) were treated with thrombolysis. At 3 months of stroke, 100 patients were alive and self-independent (25 %). The increases of thrombolytic procedures (p = 0.0171), of self-independent patients (p = 0.0036), and of patients arriving within 3 h of stroke (p = 0.0226) were statistically significant. In conclusion, our study shows that a specific plan increases the numbers of thrombolysis and of self-independent patients at 3 months of stroke.
authors.affiliation: Unità Operativa Neurologia, Stroke-Unit, Policlinico San Marco, Corso Europa 7, 24040, Osio Sotto, BG, Italy, claffra@tin.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Camerlingo
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Asero
authors.forename: Laura
authors.initials: L
authors.lastname: Perego
authors.forename: Catiuscia
authors.initials: C
authors.lastname: Rovaris
authors.forename: Marcello
authors.initials: M
authors.lastname: Tognozzi
authors.forename: Luca
authors.initials: L
authors.lastname: Moschini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galbiati
authors.forename: Emilio
authors.initials: E
authors.lastname: Pozzi
authors.forename: Oliviero
authors.initials: O
authors.lastname: Valoti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology; D004632:Emergency Medical Services / Q000191:economics / Q000379:methods / Q000592:standards; D005260:Female; D006306:Health Surveys; D006752:Hospital Planning; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome