Stroke thrombolysis: <i>per ardua, ad astra</i> …

Bladin, Christopher

doi:10.1111/imj.12337

Cited by 3 publications

(4 citation statements)

References 26 publications

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“…Accurate times of the onset of symptoms were poorly described on the ePCRs making it difficult to assess the 3-hour time window. Patients whose time of onset is unknown cannot have thrombolysis due to the uncertainty of whether they are within the treatment time-window (3,38). The majority of patients were transported as high priority and most patients were transported to a hospital with an acute stroke care service.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Stroke Identification by Paramedics in a Metropolitan Prehospital Setting: A Cohort Study

Williams

Blacker

Arendts

et al. 2017

Australasian Journal of Paramedicine

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ObjectivesAcute stroke is a medical emergency. Identifying patients suffering a stroke is crucial if paramedics are to maximize delivery of appropriate management. One suggested stroke recognition tool is ‘FAST’ (Face, Arms, Speech, Time) but the accuracy of identifying stroke is unknown. We aimed to (1) examine how paramedics identify patients with stroke; (2) compare paramedic identification of stroke with the Emergency Department (ED) discharge diagnosis of stroke.Methods A retrospective cohort study was conducted in the Perth metropolitan area in Western Australia between July 2012 and June 2014 using linked data from ambulance and ED databases. Patients aged 45+ years, transported to ED by road ambulance and assigned the ambulance problem code or ED discharge diagnosis of stroke were selected. Positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity were calculated. Text fields were examined for documentation that patients met FAST criteria.Results There were 2,217 patients were identified as stroke by paramedics. Of 1834 patients diagnosed as stroke in ED, 876 patients were not identified as stroke by paramedics. Sensitivity for identification of stroke was 958/1834 (52.2%). Of 2,096 patients who were identified as stroke by paramedics and had an ED record, 958 patients were identified as stroke by paramedics and in ED. PPV was 958/2096 (45.7%), NPV 99.5% and specificity 99.4%. Paramedics recorded 2 or 3 stroke signs and symptoms in 1,137 (51%) patients.Conclusion A systematic approach is needed to better identify patients with stroke in the prehospital setting.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Stroke Identification by Paramedics in a Metropolitan Prehospital Setting: A Cohort Study

Williams

Blacker

Arendts

et al. 2017

Australasian Journal of Paramedicine

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“…The recent editorial by Bladin mentions controversy about stroke thrombolysis but fails to address it. 1 Stroke is indeed a 'complex and heterogeneous disease' but the statement that it 'defies containment within the context of traditional research methodologies' indicates we may have given up trying to determine properly whether thrombolysis really works. We argue that the complexity of stroke makes the pursuit of high-quality evidence more essential, something that has not been achieved to date for this subject.…”

Section: General Correspondencementioning

confidence: 99%

Stroke thrombolysis remains unproven: per ardua, ad astra …

Fatovich

Brown

2014

Internal Medicine Journal

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“…Expertise is needed due to a possible misdiagnosis of stroke mimics and a potential risk of intracerebral haemorrhage if administered to patients who are inappropriate for the treatment . Although recent meta‐analytic work illustrates the effectiveness of rt‐PA regardless of age and stroke severity and its cost‐effectiveness, this treatment is not without controversy . For example, in the statement on intravenous thrombolysis for ischaemic stroke (updated March 2014), The Australian College of Emergency Medicine states that ‘it cannot currently be considered a “standard of care” ’.…”

Section: Introductionmentioning

confidence: 99%

“…3 Although recent metaanalytic work illustrates the effectiveness of rt-PA regardless of age and stroke severity 5 and its cost-effectiveness, 6 this treatment is not without controversy. [7][8][9][10][11][12][13] For example, in the statement on intravenous thrombolysis for ischaemic stroke 7 (updated March 2014), The Australian College of Emergency Medicine states that 'it cannot currently be considered a "standard of care" '. In turn, however, Fitzgerald and Gerraty 14 indicated that 'A coordinated system of care for stroke and transient ischaemic attack in Australia has been stalled by the lack of a concerted effort to adopt thrombolysis'.…”

Section: Introductionmentioning

confidence: 99%