title: Trends in yield of a code stroke program for enhancing thrombolysis.
abstract: As the benefit of thrombolytic therapy in acute ischemic stroke is time-dependent, a code stroke program needs to be implemented, maintained, and improved with continuous efforts to expedite thrombolytic therapy. We analyzed the long-term yield and efficiency of our code stroke program. Using a prospective single-center registry, we assessed the rates of stroke diagnosis and thrombolysis, door-to-CT scan and door-to-needle times, and annual trends in patients with code stroke activation between May 2007 and December 2011. Of the 791 patients with code stroke activation during the 4.7 year study period, 626 (79.1%) had a stroke, with 461 (58.3%) ischemic strokes and 165 (20.9%) hemorrhagic strokes. Along with an increase of code stroke activation (from 105/year to 236/year) and thrombolytic therapy volumes (from 24/year to 77/year), the rate of thrombolytic therapy among ischemic stroke patients increased from 33.3% to 59.2% (p for trend=0.0001). However, code activations for a non-stroke case also significantly increased (p for trend=0.0001). Door-to-CT scan time (p for trend=0.0011) and proportion of CT scan initiation ⩽ 25 minutes after arrival improved (p for trend=0.0022), and were 18.4 minutes and 76.7%, respectively, in 2011. However, the door-to-needle time and proportion of door-to-needle time ⩽ 60 minutes did not significantly improve, they were (43.3 minutes and 83.1%, respectively, in 2011). Our code stroke program yielded a high rate of detecting thrombolysis candidates and a continuous increase in rates of administration of thrombolytic therapy. These findings support the stroke team members' collaborative effort to treat more patients and to treat patients faster.
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, 2240 Daewha-dong, Ilsanseo-gu, Goyang City, Gyeonggi-do 411-706, Republic of Korea.
authors.forename: Ahro
authors.initials: A
authors.lastname: Kim
authors.affiliation: Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Republic of Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, 2240 Daewha-dong, Ilsanseo-gu, Goyang City, Gyeonggi-do 411-706, Republic of Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, 2240 Daewha-dong, Ilsanseo-gu, Goyang City, Gyeonggi-do 411-706, Republic of Korea.
authors.forename: Young Min
authors.initials: YM
authors.lastname: Paek
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, 2240 Daewha-dong, Ilsanseo-gu, Goyang City, Gyeonggi-do 411-706, Republic of Korea.
authors.forename: Kyuyoon
authors.initials: K
authors.lastname: Chung
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, 2240 Daewha-dong, Ilsanseo-gu, Goyang City, Gyeonggi-do 411-706, Republic of Korea.
authors.forename: Ji-Hyeon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, 2240 Daewha-dong, Ilsanseo-gu, Goyang City, Gyeonggi-do 411-706, Republic of Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, 2240 Daewha-dong, Ilsanseo-gu, Goyang City, Gyeonggi-do 411-706, Republic of Korea. Electronic address: nrhks@paik.ac.kr.
authors.forename: Keun-Sik
authors.initials: KS
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D012042:Registries; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data* / Q000639:trends
keywords: Code stroke program; Thrombolysis; Trends; Yield