title: Agreement Among Stroke Faculty and Fellows in Treating Ischemic Stroke Patients With Tissue-Type Plasminogen Activator and Thrombectomy.
abstract: OBJECTIVE
  The aim of this study is to determine agreement among vascular neurology fellows and faculty in treating patients with acute ischemic stroke with intravenous tissue-type plasminogen activator and intra-arterial thrombectomy (IAT).
  
  
  METHODS
  Patients were evaluated simultaneously by at least 2 vascular neurology. Agreement was determined using kappa (κ) and intraclass correlation coefficients.
  
  
  RESULTS
  In 60 patients, agreement was substantial for tissue-type plasminogen activator (κ=0.75 [95% confidence interval, 0.57-0.92]) and IAT (κ=0.63 [95% confidence interval, 0.30-0.96]), with no difference between fellow-fellow versus fellow-faculty. Intraclass correlation coefficient for National Institutes of Health Stroke Scale was 0.94 (95% confidence interval, 0.90-0.97) and κ for Alberta Stroke Program Early CT Score was 0.53 (95% confidence interval, 0.20-0.78). Rapidly improving or mild deficits caused disagreement for both tissue-type plasminogen activator and IAT, whereas interpretation of computed tomographic perfusion led to disagreement for IAT.
  
  
  CONCLUSIONS
  We found substantial agreement between vascular neurology fellows and faculty in treating with tissue-type plasminogen activator or IAT. Areas for improvement include recognition of stroke mimics, consensus on treating less severe strokes, and use/interpretation of imaging.
authors.affiliation: From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.). ahmad.riad.ramadan@gmail.com.
authors.forename: Ahmad-Riad
authors.initials: AR
authors.lastname: Ramadan
authors.affiliation: From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.).
authors.forename: Mary Carter
authors.initials: MC
authors.lastname: Denny
authors.affiliation: From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.).
authors.forename: Farhaan
authors.initials: F
authors.lastname: Vahidy
authors.affiliation: From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.).
authors.forename: Jose-Miguel
authors.initials: JM
authors.lastname: Yamal
authors.affiliation: From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.).
authors.forename: Tzu-Ching
authors.initials: TC
authors.lastname: Wu
authors.affiliation: From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.).
authors.forename: Amrou
authors.initials: A
authors.lastname: Sarraj
authors.affiliation: From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.).
authors.forename: Sean
authors.initials: S
authors.lastname: Savitz
authors.affiliation: From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.).
authors.forename: James
authors.initials: J
authors.lastname: Grotta
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D000066491:Clinical Decision-Making / Q000379:methods; D005180:Faculty, Medical; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D007396:Internship and Residency / Q000379:methods; D011446:Prospective Studies; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D017131:Thrombectomy / Q000706:statistics & numerical data; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: faculty; quality improvement; stroke; thrombectomy; tissue-type plasminogen activator