Stroke thrombolysis in the emergency department as an alternative service for community hospitals lacking a stroke unit

Barroso, Bruno; Morisset, C.; Larrieu, Jean-Marc; Bertandeau, E.; Dakar, A.; Mangon, Hervé; Rouanet, François

doi:10.1097/mej.0b013e32823a3cc1

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…In an ana lysis from the same registry that examined trends in use of tPA between 2003 and 2008, the adjusted odds ratio of thrombolysis was slightly higher in men compared with women (adjusted OR: 1.06; 95% CI: 1.00-1.12) [28]. In the USA, a study of consecutive ischemic stroke patients seen at 32 academic centers found that IV tPA treatments rates were comparable in men and women (7.5 vs 6.5%, respectively, p = 0.49) [29], while data from the Get With the Guidelines Stroke registry from 2003 to 2008 found that, among ischemic stroke cases who arrived within 2 h of symptom onset, Arrich (2008) [57] Barroso (2007) [58] Bray (2006) [59] Brown (2004) [60] Foerch (2007) [61] Heuschmann (2004) [62] Johnston (2001) [63] Kapral (2005) [64] Katzan (2000) [65] Qureshi (2005) [66] Reed (2001) [67] Reid (2008) [68] Schumacher (2007) [69] Schwammenthal (2004) [70] Walters (2005) [71] Weimar (2006) [72] Overall (95% CI)…”

Section: Utilization Of IV Tpamentioning

confidence: 99%

Thrombolysis Treatment for Acute Stroke: Issues of Efficacy and Utilization in Women

Reeves

Wilkins

Lisabeth

et al. 2011

Womens Health (Lond Engl)

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for acute ischemic stroke. If given within 3 h [7], and possibly up to 4.5 h [8], tPA can significantly reduce the level of disability observed in patients 90 days after treatment. Despite the promise of tPA therapy, the stroke community has found it challenging to implement this treatment effectively and equitably in many communities. The proportion of ischemic stroke patients who are actually treated with tPA has historically been low, often not reaching more than 3-4% of all ischemic stroke admissions in the USA [9], although more recent data from national quality improvement registries, such as Get With the Guidelines ® Stroke have shown great improvements in the p roportion of eligible stroke patients treated [10].The availability of tPA treatment for acute ischemic stroke has raised two important sexbased issues, one related to the potential for sex differences in the efficacy of tPA, and the other related to sex differences in the utilization of tPA. Empirical data illustrating the potential for sex differences in the efficacy of tPA was first shown by Kent and colleagues [11], who undertook a pooled ana lysis of three randomized placebo-controlled clinical trials of IV tPA [7,[12][13][14]. The analysis showed that women received a substantially greater benefit from tPA treatment compared with men. These results were interpreted as showing that tPA had the potential to eliminate the sex difference in functional outcomes poststrokeThe importance of stroke in women is gaining increasing recognition in both clinical and public health environments [1,2]. Because of the increased life expectancy of women, there are more stroke events in women than in men, even though in all but the very oldest age groups age-specific incidence and mortality rates are higher in men than women [1]. Stroke is also important in women because women appear to not fare as well after a stroke event compared with men; stroke-related outcomes, including disability, functional status and quality of life are consistently poorer in women than in men, yet the reasons for this are not well understood [3,4]. Some of the reasons for poor poststroke outcomes undoubtedly stem from the fact that women are older (by approximately an average of 4 years) than men when they have stroke, but accounting for these age differences or differences in the burden of risk factors and comorbidities prior to the stroke event does not account for all of these observed differences [1]. The impact of stroke on women is also exacerbated by the fact that elderly women, compared with their male counterparts, are much more likely to live alone and be socially isolated at the time of their stroke, and so may be less able to adapt to the changes that a stroke event imparts [5,6].A major development in the treatment of stroke over the last 15 years has been the approval of intravenous tissue thrombolysis (IV tPA) therapy ReviewThrombolysis treatment for acute stroke: issues of efficacy and utilization in women Background: Some studies report that women with ischemic stro...

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Section: Utilization Of IV Tpamentioning

confidence: 99%

Thrombolysis Treatment for Acute Stroke: Issues of Efficacy and Utilization in Women

Reeves

Wilkins

Lisabeth

et al. 2011

Womens Health (Lond Engl)

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“…Proper monitoring protocols for the use of intravenous tPA and other acute therapies should be developed and in place with adequate in-service training of key personnel. 35,83 Key ED personnel should participate in educational activities related to stroke diagnosis and treatment at least 2 times per year. 9 Written documents that detail the ED operations for managing patients with acute stroke should be provided.…”

Section: Emergency Departmentmentioning

confidence: 99%

Revised and Updated Recommendations for the Establishment of Primary Stroke Centers

Alberts

Latchaw

Jagoda

et al. 2011

Stroke

195

167

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for the Brain Attack CoalitionBackground and Purpose-The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. Methods-We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Results-Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Conclusions-Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center. (Stroke. 2011;42:2651-2665.)

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“…This study reports on a novel training model in the setting of a regional strategy on the care of AIS, whose greatest challenges are the time-dependency of thrombolysis therapy and the accessibility of patients to this treatment [7,8]. The final test results demonstrated that trainees had acquired the relevant knowledge and skills.…”

Section: Discussionmentioning

confidence: 96%

Development of an acute ischemic stroke management course for hospital physicians in emergency departments and intensive care units

Navarrete-Navarro

Murillo-Cabeza²,

Bono-de-Seras³

et al. 2012

European Journal of Emergency Medicine

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The objective of this study was to evaluate a training course on acute ischemic stroke (AIS) for hospital physicians, part of a regional strategy on AIS patient care. The course comprised an initial self-study (e-Learning) stage and 1-day theoretical-practical course on initial AIS management for Critical Care and Emergency physicians in the Andalusian Health Service (Spain). Data were collected on regional implementation of the stroke code and intravenous thrombolysis treatment. Between 2006 and 2009, 12 courses were attended by 356 physicians from emergency (n=148) and critical care (n=208) departments in the Andalusian health system. The initial stage was failed by 46.4% of trainees; the 1-day AIS course was successfully completed by all trainees, who reported a high satisfaction level. By the end of 2009, all hospitals had adopted the stroke code and approximately 5-6% of patients with AIS received intravenous thrombolysis. This type of healthcare strategy proved effective to improve AIS care in our setting.

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Stroke thrombolysis in the emergency department as an alternative service for community hospitals lacking a stroke unit

Cited by 6 publications

References 20 publications

Thrombolysis Treatment for Acute Stroke: Issues of Efficacy and Utilization in Women

Thrombolysis Treatment for Acute Stroke: Issues of Efficacy and Utilization in Women

Revised and Updated Recommendations for the Establishment of Primary Stroke Centers

Development of an acute ischemic stroke management course for hospital physicians in emergency departments and intensive care units

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