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Speedy Transport to Hospital Appears to Reap Few tPA-Eligible Stroke Patients: Presented at AAN

By Jill Stein

Special to DG News

DENVER, CO -- April 18, 2002 -- New findings suggest that transporting all possible stroke patients to the hospital with the purpose of initiating tissue type plasminogen activator (tPA) therapy is likely to reap only a relatively small percentage of patients eligible for the drug, researchers have found.

The data were reported by Dr. David L. Tirschwell and colleagues from the Harborview Medical Center in Seattle, Washington, United States, at the 54^th Annual Meeting of the American Academy of Neurology (AAN).

A population-based review of pre-hospital and in-hospital records for patients in Seattle, Washington over an 18-month period revealed that just 17 percent of ischemic stroke patients who called 911 were tPA-eligible.

Eligibility for tPA was defined as having a National Institutes of Health Stroke Severity (NIHSS) score greater than four and arriving at the hospital within two hours of symptom onset, said Dr. Tirschwell.

Overall, 993 patient records were reviewed. Patients included all those with a pre-hospital cerebrovascular event (CVE) diagnosis, plus selected patients with a pre-hospital diagnosis of decreased level of consciousness or headache suggestive of a CVE. In-hospital records were reviewed at all acute care hospitals in the city. Final diagnoses were based on investigator review of abstracted in-hospital records.

Intravenous tPA for the treatment of stroke is a time-dependent therapy and is more likely to improve outcome if given earlier in the three -hour time window, said Dr. Tirschwell.

In the U.S., the use of Emergency Medical Services (calling "911") has been shown to be the fastest way to get medical attention. The objective of the study was therefore to determine the proportion of ischemic stroke patients evaluated after 911 calls who might benefit from the fastest possible transport to the hospital despite the risk inherent in such transport.

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