Stroke code impact on the efficacy of thrombolytic treatment

BACKGROUND AND OBJECTIVES: Most stroke patients arrive to emergency rooms too late, many times beyond the therapeutic window for thrombolysis. The activation of a Stroke Code (SC) has proven to be effective in decreasing the latency time for starting therapy in clinical trials. However, its usefulness in routine clinical practice is uncertain. The aim of this study was to determine the feasibility of applying an SC in the daily clinical practice and to evaluate its impact on the efficacy of t-PA thrombolytic treatment. PATIENTS AN METHOD: We included middle-cerebral artery stroke patients treated with IV t-PA from June 2000 to December 2001 who were categorized into three periods of 6 months each. The influence of SC activation on the latency time, arterial recanalization and early neurological recovery was evaluated. RESULTS: Forty-eight patients were prospectively studied. A significant increase in the number of t-PA treated patients was observed in the three periods (4.8%, 5.3% and 8%). A significant progressive decrease (p = 0.036) in the overall delay to start t-PA was observed (from 161.4 to 130 minutes). The proportion of t-PA treated patients in whome SC was activated increased gradually (p = 0.032). SC activation reduced time from symptom onset to hospital arrival (p = 0.013) as well as the "door-to-needle" time (p = 0.049). The rate of early recanalization (p = 0.027) and neurological recovery (p = 0.036) at 48 hours was significantly higher in patients in whom SC was activated than in those in whom SC was not. CONCLUSIONS: SC activation is very useful in the management of acute stroke, increasing the rate of t-PA treated patients and improving the clinical outcome.