title: Impact of a direct-admission stroke pathway on delays of admission, care, and rates of intravenous thrombolysis.
abstract: BACKGROUND
  This study examined the impact of a "direct potential thrombolysis" pathway with direct admission to a neurological stroke unit (SU) on delays of admission, stroke care and proportion of patients with ischemic stroke (IS) treated with intravenous (IV) rtPA.
  
  
  METHODS
  This prospective study included all patients admitted in the intensive SU for potential thrombolysis over a 2-month period. Data collected included the time of symptom onset, mode of transport, National Institutes of Health Stroke Scale (NIHSS) score on arrival, delays of care, delays of imaging and modalities, diagnosis and therapeutic data.
  
  
  RESULTS
  During the 2-month study period, 81 patients (mean age of 65 years) were included in the study. The Emergency Medical Services (EMS) were involved in 86% of admissions, with a median delay of admission of 1h48 and access within 4.5h in 84% of cases. Every patient underwent immediate neurovascular assessment and imaging examination, which was a MRI in 80% of cases. Only 70% of patients had a final diagnosis of stroke. Intravenous rtPA therapy was administered to 26 patients (32%), and 58% of patients with IS. The median door-to-needle time delay was 63min.
  
  
  CONCLUSIONS
  A direct 'potential thrombolysis' pathway, based on EMS and located in the SU, can result in earlier admission, reaching the recommended care delay, and a large proportion (58%) of IS patients receiving rtPA therapy. On the other hand, the proportion of patients with stroke mimics is high, thereby increasing the chances of intermittent periods of saturation of this specific pathway.
authors.affiliation: Stroke Unit, University Hospital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France. Electronic address: Capucine.mouthon@etu.univ-tours.fr.
authors.forename: C
authors.initials: C
authors.lastname: Mouthon-Reignier
authors.affiliation: Stroke Unit, University Hospital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France.
authors.forename: I
authors.initials: I
authors.lastname: Bonnaud
authors.affiliation: Stroke Unit, University Hospital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France.
authors.forename: M
authors.initials: M
authors.lastname: Gaudron
authors.affiliation: Emergency Department, University Hospital Trousseau, avenue de la République, 37170 Chambray-les-Tours, France; SAMU 37, Emergency Medical Services, University Hospital Trousseau, avenue de la République, 37170 Chambray-les-Tours, France.
authors.forename: S
authors.initials: S
authors.lastname: Vannier-Bernard
authors.affiliation: Emergency Department, University Hospital Trousseau, avenue de la République, 37170 Chambray-les-Tours, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Bodin
authors.affiliation: Neuroradiology Department, University Hospital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France; Francois Rabelais University, 10, boulevard Tonnellé, 37032 Tours cedex 1, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Cottier
authors.affiliation: Francois Rabelais University, 10, boulevard Tonnellé, 37032 Tours cedex 1, France; Neurology Department, University Hospital Bretonneau, 2, boulevard Tonnellé, 37000 Tours, France; Inserm 930 Department, University Hospital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France.
authors.forename: B
authors.initials: B
authors.lastname: De Toffol
authors.affiliation: Stroke Unit, University Hospital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France.
authors.forename: S
authors.initials: S
authors.lastname: Debiais
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000628:therapy; D057210:Delayed Diagnosis; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006748:Hospital Departments; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute stroke; Direct admission pathway; Emergency Medical Services; Stroke unit; Thrombolysis