Ultra-rapid identification, triage, and enrollment of stroke patients into clinical trials.
Effective therapy for acute ischemic stroke will require very rapid evaluation of patients so that treatment can begin soon enough to salvage injured but viable brain. Limited data suggest that neurons in the ischemic penumbra survive for a few hours, at the most. It is critical to know whether our medical system can overcome the many practical obstacles to ultra-rapid recognition,, transport, and treatment of stroke patients. We analyzed our patient recruitment into clinical treatment trials over time, attempting to identify strategies that improved recruitment. Specifically, we studied whether the imposition of an ultra-short time limit for treatment initiation, 3 h from stroke onset, impaired recruitment Prior to adopting the strict time limit, we enrolled about 0.4 patients per month per participating hospital. After adopting the limit, we enrolled about 0.7 patients per month per hospital. Our data indicate that patient recruitment may be maintained and even increased despite a demanding time limit for treatment. The data also suggest that a very short time window of survivability of the ischemic penumbra should not discourage efforts to develop new methods of salvaging brain, for we have shown that the medical delivery system in one county can be modified to allow ultra-rapid patient recognition, evaluation, and treatment.
From the Department of Neurosciences, UCSD School of Medicine, and Department of Neurology, Veterans Administration Medical Center, San Diego, CA, U.S.A.
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Lyden
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