title: Problems and limitations in thrombolysis of acute stroke patients at a tertiary care center.
abstract: OBJECTIVE
  (1) To evaluate the number of patients thrombolysed within 1 h of arrival to emergency room (ER) (2) To identify reasons for delay in thrombolysis of acute stroke patients.
  
  
  METHODS
  All patients admitted to ER with symptoms suggestive of stroke from January 2011 to November 2013 were studied. Retrospective data were collected to evaluate ER to needle (door to needle time [DTNt]) time and reasons for delay in thrombolysis. The parameters studied (1) onset of symptoms to ER time, (2) ER to imaging time (door to imaging time [DTIt]), (4) ER to needle time (door to needle) and (5) contraindications for thrombolysis.
  
  
  RESULTS
  A total of 695 patients with suspected stroke were admitted during study period. 547 (78%) patients were out of window period. 148 patients (21%, M = 104, F = 44) arrived within window period (<4.5 h.). 104 (70.27%) were contraindicated for thrombolysis. Majority were intracerebral bleeds. 44 (29.7%) were eligible for thrombolysis. 7 (15.9%) were thrombolysed within 1 h. The mean time for arrival of patients from onset of symptoms to hospital (symptom to door) 83 min (median - 47). The mean door to neuro-physician time (DTPt) was 32 min (median - 15 min). The mean DTIt was 58 min (median - 50 min). The mean DTNt 104 (median - 100 min).
  
  
  CONCLUSIONS
  Reasons for delay in thrombolysis are: Absence of stroke education program for common people. Lack of priority for triage and imaging for stroke patients.
authors.affiliation: Intensivist, Neuro-Trauma Unit, Ruby Hall Clinic, Pune, India.
authors.forename: Sushma K
authors.initials: SK
authors.lastname: Gurav
authors.affiliation: Director, Neuro-Trauma Unit, Ruby Hall Clinic, Pune, India.
authors.forename: Kapil G
authors.initials: KG
authors.lastname: Zirpe
authors.affiliation: Director, Neuro-Sciences, Ruby Hall Clinic, Pune, India.
authors.forename: R S
authors.initials: RS
authors.lastname: Wadia
authors.affiliation: Intensivist, Neuro-Trauma Unit, Ruby Hall Clinic, Pune, India.
authors.forename: Manishprasad K
authors.initials: MK
authors.lastname: Pathak
authors.affiliation: Intensivist, Neuro-Trauma Unit, Ruby Hall Clinic, Pune, India.
authors.forename: Abhijeet M
authors.initials: AM
authors.lastname: Deshmukh
authors.affiliation: Chief Resident, Medicine, Ruby Hall Clnic, Pune, India.
authors.forename: Rahul V
authors.initials: RV
authors.lastname: Sonawane
authors.affiliation: Chief Resident, Medicine, Ruby Hall Clnic, Pune, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Goli
keywords: Acute ischemic stroke; thrombolysis triage and stroke code team; window period