title: Code stroke in Asturias.
abstract: BACKGROUND
  Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available.
  
  
  METHODS
  We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient.
  
  
  RESULTS
  We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score.
  
  
  CONCLUSIONS
  Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible.
authors.affiliation: Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España. Electronic address: lbf.benfer@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Benavente
authors.affiliation: Servicio de Asistencia Médica Urgente de Asturias, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Villanueva
authors.affiliation: Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: P
authors.initials: P
authors.lastname: Vega
authors.affiliation: Sección de Neurología, Hospital de Cabueñes, Gijón, España.
authors.forename: I
authors.initials: I
authors.lastname: Casado
authors.affiliation: Sección de Neurología, Hospital San Agustín, Avilés, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Vidal
authors.affiliation: Sección de Neurología, Hospital Valle del Nalón, Langreo, España.
authors.forename: B
authors.initials: B
authors.lastname: Castaño
authors.affiliation: Sección de Neurología, Fundación Hospital de Jove, Gijón, España.
authors.forename: M
authors.initials: M
authors.lastname: Amorín
authors.affiliation: Sección de Neurología, Hospital Álvarez Buylla, Mieres, España.
authors.forename: V
authors.initials: V
authors.lastname: de la Vega
authors.affiliation: Servicio de Medicina Interna, Sección de Neurología, Hospital de Jarrio, Coaña, España.
authors.forename: H
authors.initials: H
authors.lastname: Santos
authors.affiliation: Servicio de Asistencia Médica Urgente de Asturias, España.
authors.forename: A
authors.initials: A
authors.lastname: Trigo
authors.affiliation: Servicio de Asistencia Médica Urgente de Asturias, España.
authors.forename: M B
authors.initials: MB
authors.lastname: Gómez
authors.affiliation: Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: D
authors.initials: D
authors.lastname: Larrosa
authors.affiliation: Sección de Neurología, Hospital de Cabueñes, Gijón, España.
authors.forename: T
authors.initials: T
authors.lastname: Temprano
authors.affiliation: Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: M
authors.initials: M
authors.lastname: González
authors.affiliation: Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: E
authors.initials: E
authors.lastname: Murias
authors.affiliation: Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: S
authors.initials: S
authors.lastname: Calleja
mesh_terms: D002545:Brain Ischemia / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D015424:Reperfusion; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000145:classification* / Q000453:epidemiology / Q000628:therapy*; D017131:Thrombectomy / Q000706:statistics & numerical data*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Code stroke; Código ictus; Fibrinolysis; Fibrinólisis; Gravedad-tiempo; Health district; Severity-time; Thrombectomy; Trombectomía; Áreas sanitarias