- Title
- Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in acute ischaemic stroke: an audit of current practice and clinical outcomes
- Creator
- Williams, Jocelyn M.; Navin, Tina J.; Jude, Martin R.; Levi, Christopher R.
- Relation
- Australian Journal of Rural Health Vol. 21, Issue 4, p. 203-207
- Publisher Link
- http://dx.doi.org/10.1111/ajr.12038
- Publisher
- Wiley-Blackwell Publishing Asia
- Resource Type
- journal article
- Date
- 2013
- Description
- Objective: This audit of activity reports on current rates of recombinant tissue plasminogen activator (rt-PA) use within specialised stroke care units in rural New South Wales (NSW). It measures stroke onset-to-treatment time and morbidity outcomes for patients treated with rt-PA and aims to establish the safety and effectiveness of rt-PA use in rural NSW. Design, setting and participants: Medical records reviews of patients admitted with acute ischaemic stroke at two rural NSW hospitals between 1 July 2008 and 30 June 2010. Main outcome measures: Treatment with rt-PA, morbidity scores 5 days post-stroke or discharge, incidence of intracranial haemorrhage and mortality rate 6 months post-stroke were recorded. Treatment protocol violations were assessed and time to treatment from stroke onset and hospital admission. Results: Of 605 patients admitted with acute ischaemic stroke, 20 (3.3%) received rt-PA treatment. Of these two, 10% had symptomatic intracranial haemorrhage and one died within 6 months. Morbidity scores for those treated with rt-PA were similar to those not treated. The median onset-to-needle time was 2 hours and 34 min, and the median door-to-needle time was 1 hour and 40 min. There were no treatment protocol violations. Conclusion: Recombinant tissue plasminogen activator can be delivered in rural Australian hospitals in a timely manner within recommended implementation guidelines. Acute stroke thrombolytic services in rural Australian facilities had comparable outcomes to metropolitan facilities. Small numbers of thrombolysed patients prevented a validation study of the well-defined outcome benefits from rt-PA. The need for ongoing data collection in regional settings is supported.
- Subject
- emergency medicine; outcome; physician; thrombolysis; thrombolytic therapy
- Identifier
- http://hdl.handle.net/1959.13/1298807
- Identifier
- uon:19727
- Identifier
- ISSN:1038-5282
- Language
- eng
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