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The chain of care enabling tPA treatment in acute ischemic stroke: a comprehensive review of organisational models

Lahr, M. M. H., Luijckx, G-J., Vroomen, P., van der Zee, D. J. & Buskens, E., Apr-2013, In : Journal of Neurology. 260, 4, p. 960-968 9 p.

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Protracted and partial implementation of treatment with intravenous tissue plasminogen activator (tPA) within 4.5 h after acute stroke onset results in potentially eligible patients not receiving optimal treatment. The goal of this study was to review the performance of various organisational models of acute stroke care delivery, and subsequent attempts to improve implementation of tPA treatment. Publications comprehensively reporting on organisational models to improve implementation of i.v. tPA treatment of acute ischemic stroke patients were selected. The efficacy of organisational models was assessed using process outcome measures: thrombolysis rates, time-dependent operational endpoints (time delays), functional outcomes: safety (rate of symptomatic intracranial hemorrhage, mortality rates) and clinical outcome at 90 days (modified Rankin Scale). Fifty-eight published studies assessing organisational models were identified. Four dominant models of acute stroke care delivery were discerned, i.e., primary and comprehensive stroke centres, telemedicine, and the mobile stroke unit. Performance reported for these models suggest a large variation in administration of thrombolytic therapy (0.7-30 %). Time delays and functional outcomes found varied considerably, just like safety and mortality (0.0-11.5 %, and 3.4-31.9 %, respectively). These findings suggest that improving organisational models for tPA treatment may improve acute stroke care. However, implementation may be hampered by regional variation in acute stroke care capacity, expertise, and a fragmented approach towards organising stroke care.

Original languageEnglish
Pages (from-to)960-968
Number of pages9
JournalJournal of Neurology
Volume260
Issue number4
Publication statusPublished - Apr-2013

    Keywords

  • Acute stroke, Thrombolysis, Organisational model, Implementation, TISSUE-PLASMINOGEN ACTIVATOR, DIGITAL OBSERVATION CAMERA, TELEMEDIC PILOT PROJECT, BRAIN ATTACK COALITION, IN-HOSPITAL DELAY, INTRAVENOUS THROMBOLYSIS, REMOTE EVALUATION, TELESTROKE NETWORK, CENTER EXPERIENCE, UNITED-STATES

ID: 5839403