title: Acute stroke care and thrombolytic therapy use in a tertiary care center in Lebanon.
abstract: Background. Thrombolytic therapy (rt-PA) is approved for ischemic stroke presenting within 4.5 hours of symptoms onset. The rate of utilization of rt-PA is not well described in developing countries. Objectives. Our study examined patient characteristics and outcomes in addition to barriers to rt-PA utilization in a tertiary care center in Beirut, Lebanon. Methods. A retrospective chart review of all adult patients admitted to the emergency department during a one-year period (June 1st, 2009, to June 1st, 2010) with a final discharge diagnosis of ischemic stroke was completed. Descriptive analysis was done followed by a comparison of two groups (IV rt-PA and no IV rt-PA). Results. During the study period, 87 patients met the inclusion criteria and thus were included in the study. The mean age was found to be 71.9 years (SD = 11.8). Most patients arrived by private transport (85.1%). Weakness and loss of speech were the most common presenting signs (56.3%). Thirty-three patients (37.9%) presented within 4.5 hours of symptom onset. Nine patients (10.3%, 95% CI (5.5-18.5)) received rt-PA. The two groups (rt-PA versus non rt-PA) had similar outcomes (mortality, symptomatic intracerebral hemorrhage, modified Rankin scale scores, and residual deficit at hospital discharge). Conclusion. In our setting, rt-PA utilization was higher than expected. Delayed presentation was the main barrier to rt-PA administration. Public education regarding stroke is needed to decrease time from symptoms onset to ED presentation and potentially improve outcomes further.
authors.affiliation: Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon ; Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
authors.forename: Mazen J
authors.identifier: 0000-0001-9679-1131
authors.initials: MJ
authors.lastname: El Sayed
authors.affiliation: Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
authors.forename: Tharwat
authors.identifier: 0000-0002-1182-2435
authors.initials: T
authors.lastname: El Zahran
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim