title: A systemized stroke code significantly reduced time intervals for using intravenous tissue plasminogen activator under magnetic resonance imaging screening.
abstract: BACKGROUND
  A stroke code can shorten time intervals until intravenous tissue plasminogen activator (IV t-PA) treatment in acute ischemic stroke (AIS). Recently, several reports demonstrated that magnetic resonance imaging (MRI)-based thrombolysis had reduced complications and improved outcomes in AIS despite longer processing compared with computed tomography (CT)-based thrombolysis.
  
  
  METHODS
  In January 2009, we implemented CODE RED, a computerized stroke code, at our hospital with the aim of achieving rapid stroke assessment and treatment. We included patients with thrombolysis from January 2007 to December 2008 (prestroke code period) and from January 2009 to May 2013 (poststroke code period). The IV t-PA time intervals and 90-day modified Rankin Scale (mRS) scores were collected.
  
  
  RESULTS
  During the observation period, 252 patients used IV t-PA under the CODE RED (MRI based: 208; CT based: 44). The remaining 71 patients (MRI based: 53; CT based: 18) received it before the implementation of our stroke code. After implementation of CODE RED, door-to-image time, door-to-needle time, and the onset-to-needle time were significantly reduced by 11, 18, and 22 minutes in MRI-based thrombolysis. Particularly, the proportion of favorable outcome (mRS score 0-2) was significantly increased (from 41.5% to 60.1%, P = .02) in poststroke than in prestroke code period in MRI-based thrombolysis. However, in ordinal regression, the presence of stroke code showed just a trend for favorable outcome (odds ratio, .99-2.87; P = .059) at 90 days of using IV t-PA after correction of age, sex, and National Institutes of Health Stroke Scale.
  
  
  CONCLUSIONS
  In this study, we demonstrated that a systemized stroke code shortened time intervals for using IV t-PA under MRI screening. Also, our results showed a possibility that a systemized stroke code might enhance the efficacy of MRI-based thrombolysis. In the future, we need to carry out a more detailed prospective study about this notion.
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Sohn
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Hyun-Seok
authors.initials: HS
authors.lastname: Park
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea. Electronic address: nrcjk65@gmail.com.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Hyun-Wook
authors.initials: HW
authors.lastname: Nah
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Dae-Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Myong-Jin
authors.initials: MJ
authors.lastname: Kang
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Jae-Taeck
authors.initials: JT
authors.lastname: Huh
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001921:Brain / Q000473:pathology*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: MRI; stroke code; t-PA; thrombolysis