An expedited code stroke protocol is feasible and safe

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. The expedited protocol includes: Benchmar...

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Veröffentlicht in:Stroke (1970) 2006-12, Vol.37 (12), p.2935-2939
Hauptverfasser: SATTIN, Justin A, OLSON, Scott E, LIN LIU, RAMAN, Rema, LYDEN, Patrick D
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container_end_page 2939
container_issue 12
container_start_page 2935
container_title Stroke (1970)
container_volume 37
creator SATTIN, Justin A
OLSON, Scott E
LIN LIU
RAMAN, Rema
LYDEN, Patrick D
description 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. 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. 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%. 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.
doi_str_mv 10.1161/01.STR.0000249057.44420.4b
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Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Male ; Medical sciences ; Middle Aged ; Nervous system (semeiology, syndromes) ; Neurology ; Pharmacology. 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In July 2003, we set a benchmark onset-to-treatment time of &lt; or =2 hours and instituted an expedited code stroke protocol to accomplish this. We aim to show that the protocol is feasible and safe. 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. 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%. 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Benchmarking - methods</subject><subject>Benchmarking - standards</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Guideline Adherence - standards</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Pharmacology. Drug treatments</subject><subject>Stroke - diagnosis</subject><subject>Stroke - drug therapy</subject><subject>Time Factors</subject><subject>Tissue Plasminogen Activator - therapeutic use</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkF1LwzAUhoMobk7_ghRB71qT5jQf3snwCwaCzuuQnCRQ7drZdKD_3s4Ndm7OzfO-5_AQcsVowZhgt5QV78u3go5TgqaVLACgpAW4IzJlVQk5iFIdkymlXOcjoifkLKXPLc9VdUomTFJdSS6mRNy3WfhZB18PwWfY-ZCloe--Qrbuu6HDrsnqlMVgU-2akNnWZ8nGcE5Oom1SuNjvGfl4fFjOn_PF69PL_H6RI1cw5IJL5N6j5lpxR7WL6ACdAmAOIgpESaOASEVZMasdOrTegowVlcg84zNys-sdv_nehDSYVZ0wNI1tQ7dJRiimlFZyBO92IPZdSn2IZt3XK9v_GkbN1pqhzIzWzMGa-bdmwI3hy_2VjVsFf4juNY3A9R6wCW0Te9tinQ6c4hwoAP8D6jJ1vg</recordid><startdate>20061201</startdate><enddate>20061201</enddate><creator>SATTIN, Justin A</creator><creator>OLSON, Scott E</creator><creator>LIN LIU</creator><creator>RAMAN, Rema</creator><creator>LYDEN, Patrick D</creator><general>Lippincott Williams &amp; Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20061201</creationdate><title>An expedited code stroke protocol is feasible and safe</title><author>SATTIN, Justin A ; OLSON, Scott E ; LIN LIU ; RAMAN, Rema ; LYDEN, Patrick D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-637c3ddc93983b09bfcb4cb8441b4fc6cc70f64f06251a9bcbcada47f507c1d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Benchmarking - methods</topic><topic>Benchmarking - standards</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Guideline Adherence - standards</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Pharmacology. Drug treatments</topic><topic>Stroke - diagnosis</topic><topic>Stroke - drug therapy</topic><topic>Time Factors</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SATTIN, Justin A</creatorcontrib><creatorcontrib>OLSON, Scott E</creatorcontrib><creatorcontrib>LIN LIU</creatorcontrib><creatorcontrib>RAMAN, Rema</creatorcontrib><creatorcontrib>LYDEN, Patrick D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SATTIN, Justin A</au><au>OLSON, Scott E</au><au>LIN LIU</au><au>RAMAN, Rema</au><au>LYDEN, Patrick D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An expedited code stroke protocol is feasible and safe</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2006-12-01</date><risdate>2006</risdate><volume>37</volume><issue>12</issue><spage>2935</spage><epage>2939</epage><pages>2935-2939</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Stroke recovery critically depends on timely reperfusion. In July 2003, we set a benchmark onset-to-treatment time of &lt; or =2 hours and instituted an expedited code stroke protocol to accomplish this. We aim to show that the protocol is feasible and safe. 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. 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%. 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.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams &amp; Wilkins</pub><pmid>17095736</pmid><doi>10.1161/01.STR.0000249057.44420.4b</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record>
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source MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection
subjects Adult
Aged
Aged, 80 and over
Benchmarking - methods
Benchmarking - standards
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Feasibility Studies
Female
Guideline Adherence - standards
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Humans
Male
Medical sciences
Middle Aged
Nervous system (semeiology, syndromes)
Neurology
Pharmacology. Drug treatments
Stroke - diagnosis
Stroke - drug therapy
Time Factors
Tissue Plasminogen Activator - therapeutic use
Vascular diseases and vascular malformations of the nervous system
title An expedited code stroke protocol is feasible and safe
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