title: An audit of coagulation screening in patients presenting to the emergency department for potential stroke thrombolysis.
abstract: OBJECTIVE
  To assess time to coagulation screening results in patients presenting for potential stroke thrombolysis.
  
  
  METHODS
  A retrospective cohort study of patients was assessed for thrombolysis for stroke at Wellington Hospital between January and June 2014. We assessed time from presentation to receipt of laboratory specimen, processing time and total time from presentation to result availability and whether times differed by receipt time.
  
  
  RESULTS
  During the audit period, 97 unique patients, and 99 clinical episodes, were assessed for stroke thrombolysis; 20 patients received thrombolysis. In 11of 99 (11%) episodes, no coagulation sample was sent. Sample was unsuitable for processing in 16 episodes (18%), and in four, a further specimen was sent. Median (interquartile range) time from presentation to the emergency department to laboratory report during working hours (n = 55) was 61 (53-77) min and out of hours (n = 33) 64 (50-90) min; Hodges-Lehmann estimator (95% CI) of location shift -1 (-11 to 8) min, P = 0.90. No difference in reporting times was seen whether patients received thrombolysis or not. Seven patients were prescribed warfarin, and one had an international normalised ratio (INR) of 1.7 and was thrombolysed. INR in the other six patients ranged between 1.9 and 3.4. Two patients using dabigatran had prolonged thrombin times and so were not thrombolysed.
  
  
  CONCLUSIONS
  A high proportion of laboratory specimens was unsuitable for testing, and overall samples took an unacceptably long time to process. Point-of-care testing may potentially allow quicker decisions regarding whether thrombolysis is contraindicated but is likely to affect only a small proportion of patients.
authors.affiliation: Department of Medicine, Capital and Coast DHB, Wellington, New Zealand.
authors.forename: Katie
authors.initials: K
authors.lastname: Thorne
authors.affiliation: Department of Neurology, Capital and Coast DHB, Wellington, New Zealand.
authors.forename: Harry
authors.initials: H
authors.lastname: McNaughton
authors.affiliation: Department of Medicine, Capital and Coast DHB, Wellington, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D000067716:Point-of-Care Testing; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D061665:Time-to-Treatment; D055815:Young Adult
keywords: coagulation; point-of-care; stroke; thrombolysis