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PubMed · 17095736

An expedited code stroke protocol is feasible and safe.

Justin A Sattin·Scott E Olson·Lin Liu·Rema Raman·Patrick D Lyden
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Abstract

BACKGROUND AND PURPOSE: Stroke recovery critically depends on timely reperfusion. In July 2003, we set a benchmark onset-to-treatment time of < or =2 hours and instituted an expedited code stroke protocol to accomplish this. We aim to show that the protocol is feasible and safe. METHODS: The expedited protocol includes: Benchmark onset-to-treatment within 2 hours; in-person triage of all code stroke patients; unmixed tissue plasminogen activator at the bedside during evaluation; no delays pending coagulation tests, chest x-ray, or stool guiac unless specifically indicated; and no delays pending formal CT interpretation or written consent. RESULTS: Between July 2003 and June 2005, we evaluated 781 patients and treated 103 of 781 (13.2%) with intravenous recombinant tissue plasminogen activator within 3 hours. Of these, we treated 49 of 103 (47.6%) within 2 hours of symptom onset, and 54 of 103 (52.4%) between 2 and 3 hours. The overall risk of symptomatic intracerebral hemorrhage was 4 of 103 (3.9%; 95% CI, 1.1%, 9.6%), and not significantly different from 6.4% (P=0.42). The hemorrhage risks in those treated within 2 hours of symptom onset and those treated between 2 and 3 hours were not significantly different from each other or from 6.4%. CONCLUSIONS: The expedited code stroke protocol is feasible and appears safe. Further study is warranted to confirm its safety and determine whether it results in better clinical outcomes.

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AdultAgedAged, 80 and overBenchmarkingFeasibility StudiesFemaleGuideline AdherenceHumansMaleMiddle AgedStrokeTime FactorsTissue Plasminogen ActivatorComparative StudyJournal ArticleResearch Support, N.I.H., ExtramuralResearch Support, U.S. Gov't, Non-P.H.S.

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Justin A Sattin, Scott E Olson, Lin Liu, Rema Raman, Patrick D Lyden. 2006-11-09. An expedited code stroke protocol is feasible and safe.. https://doi.org/10.1161/01.str.0000249057.44420.4b

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