title: Code stroke: a mismatch between number of activation and number of thrombolysis.
abstract: OBJECTIVE
  Code stroke systems are widely implemented to expedite acute stroke treatment. Although this system requires considerable resources, so far no reimbursement has been provided by the Bureau of National Health Insurance (BNHI) in Taiwan. We investigated how often a code stroke was initiated and the percentage of patients treated with intravenous (IV) tissue plasminogen activator, and draw attention to the resulting mismatch.
  
  
  METHODS
  From January 2010 to September 2011, we prospectively registered all consecutive code stroke patients. Patient characteristics, including demographic data, medical history, comorbidity conditions, treatments, and discharge diagnosis were collected, together with the exact time of onset (or last known normal time) and management. The eligibility of thrombolysis for each patient recorded originally on the chart was reviewed retrospectively on the basis of two sets of criteria, namely, the BNHI reimbursement criteria and the Taiwan Stroke Society (TSS) guideline.
  
  
  RESULTS
  During the study period, code strokes were activated for 419 patients at an average of around 20 patients per month. About 57% of code strokes were initiated outside of office hours. Stroke was diagnosed in 377 (90%) patients and 304 (73%) patients had ischemic stroke or transient ischemic attack. A total of 42 (10%) patients according to the BNHI reimbursement criteria and 101 (24%) patients by the TSS guideline were eligible for IV thrombolytic therapy. Of all the code stroke patients, only 49 (12%) were actually treated. Before each additional patient was thrombolysed, about eight patients had been evaluated and excluded from treatment.
  
  
  CONCLUSIONS
  The majority of code stroke patients were stroke patients; however, most of them could not be treated with thrombolytic therapy. These findings underscore the need for further support from the BNHI in order for health-care providers to implement the code stroke systems successfully.
authors: Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
authors: Sheng-Feng
authors: SF
authors: Sung
authors: Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan. Electronic address: mctseng@mail.nsysu.edu.tw.
authors: Mei-Chiun
authors: MC
authors: Tseng
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D004608:Eligibility Determination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D057209:Hospital Rapid Response Team; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy*; D013624:Taiwan; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute stroke; emergencies; thrombolytic therapy