ATLANTA -- Ischemic stroke patients who arrive at the hospital in an ambulance are more likely to meet the deadline for the use of tPA-three hours from symptom onset.
ATLANTA, May 17 -- Ischemic stroke patients who arrive at the hospital in an ambulance are more likely to meet the deadline for the use of tPA-three hours from symptom onset.
Even though more than half of stroke patients get to the hospital with only an hour to spare, and brain imaging is still needed before tPA can be administered safely, arriving by ambulance appears to expedite triage decisions, according to a report in the May 18 issue of Mortality and Morbidity Weekly Report.
"Both shorter pre-hospital and hospital delays will increase the proportion of ischemic stroke patients who can receive brain imaging, tPA therapy, and early secondary prevention therapies to reduce their risk for severe disability from stroke," according to the MMWR editors.
They were commenting on an MMWR report by Michael R. Frankel, M.D., of Emory University, and co-authors, who analyzed data from 142 hospitals in four states -- Georgia, Illinois, Massachusetts, and North Carolina -- that participate in the Paul Coverdell National Acute Stroke Registry.
The Emory team identified 17,643 patients who were treated from January 1, 2005 through September 30, 2006. They assessed treatment using two standard temporal measures -- the proportion of patients who arrived at the hospital within two hours of stroke symptom onset and the proportion of patients who receiving imaging within an hour of arrival at the hospital.
Just over half of the patients were women and 75.8% were white. Overall two-thirds of the patients were 65 or older. Most of the patients (65.1%) had ischemic strokes, 24% had transient ischemic attacks, and 9.7% of the strokes were hemorrhagic.
Information on stroke onset was available for 7,901 of the patients and among those 48% arrived at the emergency department within two hours of symptom onset. Whites were more likely to arrive at the hospital by the two hour mark and 56.8% of patients who called an ambulance arrived within two hours.
Among the findings: