Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke

Abstract

Background and Objectives Tissue plasminogen activator (t-PA) within 4.5 hours from onset improves outcome in patients with ischemic stroke and has been recommended by several international guidelines. Since its approval in 1996, the debate among emergency physicians continues particularly around the result interpretation of the first positive randomized controlled trial, the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial. This lack of consensus might negatively affect the delivery of effective stroke care. Here we aimed to assess the knowledge and attitude of Saudi emergency physicians toward t-PA use within 4.5 hours of onset in acute ischemic stroke. Methods A web-based, self-administered, locally designed questionnaire was sent to all emergency physicians practicing in the city of Riyadh from January to September 2017. Results Out of 450 emergency physicians, 122 from ten hospitals in Riyadh participated in the survey, with a 27% response rate. The majority of participants were men (78%), and their mean age was 40 ± 8 years. Half of the participants were board certified, and 36% were consultants. Half of the participants consider the evidence for t-PA use in stroke within 4.5 hours of stroke onset to be controversial, and 41% recommend against its use due to lack of proven efficacy (37%), the risk of hemorrhagic complications (35%), lack of stroke expertise (21%), and medicolegal liability (9%). Nearly half were willing to administer IV t-PA for ischemic stroke in collaboration with remote stroke neurology consultation if telestroke is implemented. Conclusion Our study detected inadequate knowledge and a negative attitude among Saudi emergency physicians toward t-PA use in acute stroke. This might negatively impact patient outcome. Therefore, we recommend developing urgent strategies to improve emergency physicians' knowledge, attitudes, and beliefs in the management of acute stroke.

A cross-sectional study of awareness regarding dog bite and its management in rural community of Maharashtra, India

“…The self-administered questionnaire was developed based on the review of different literature included the following sections: 5,6,8 1. Descriptive data, including age, gender, level of education, job title, nationality, years of experience, and estimated number of stroke patients seen per week.…”

“…4 A previous study conducted in Riyadh, Saudi Arabia, among emergency services personnel reported that there was a lack of knowledge of the cardinal stroke symptoms, and the uses and therapeutic time window of t-PA. 5 A recent study conducted in Riyadh, Saudi Arabia, among emergency physicians revealed a relatively low level of knowledge and the presence of negative attitudes toward t-PA use. 6 Thrombolytic programs have been implemented in many hospitals in Saudi Arabia, but the situation among hospitals in the Qassim region is currently suboptimal. Emergency and medicine physicians are the primary providers of acute stroke care in Qassim due to the current shortage of neurologists, with a total of only four neurologists in the three major hospitals in Qassim at the time of this study and the lack of stroke care organization and patient access to IV-t-PA.…”

Use of evidence in acute stroke decision‐making: Implications for evidence‐based medicine

“…Emergency doctors' knowledge is necessarily broader and shallower in scope. They have less chance to be familiar with complex neuro‐physiological concepts compared to neurologists 29,30 . And without the concept of the penumbra, and its operational correlate of the 3‐hour therapeutic window, there would indeed be no grounds to distinguish between the NINDS trial and its related trials.…”

Timely Administration of Thrombolytic Therapy in Acute Ischemic Stroke: An Ethnographic Study

“…The physicians' fears of risk of intracranial hemorrhage among other side effects of thrombolytic therapy may play a role in clinical decision to treat patients which affects the DTN [37]. Khathami et al [38] claimed that the main reasons for emergency physicians who do not recommend tPA use were that they found the said treatment lacking efficacy or effectiveness. The lack of exposure, education and awareness about eligibility could be the contributory factors [39].…”