Many Ischemic Stroke Patients Arrive at ER Within Hour

Early arrivers more often receive thrombolytic therapy, but not as quickly as late arrivers
By Eric Metcalf
HealthDay Reporter

FRIDAY, June 4 (HealthDay News) -- A substantial portion of ischemic stroke patients present to emergency departments within an hour of onset, and they are more likely to receive thrombolytic therapy than those who arrive later, but both factors present room for improvement, according to research published online June 3 in Stroke.

Jeffrey L. Saver, M.D., of the University of California in Los Angeles, and colleagues analyzed data from 106,924 patients with ischemic stroke who arrived directly by ambulance or private vehicle at emergency departments and had a documented last-known well time.

The researchers found that onset-to-door time was 60 minutes or less in 28.3 percent of patients, 61 to 180 minutes in 31.7 percent, and more than 180 minutes in 40.1 percent. Characteristics most strongly associated with early arrival included severe neurologic deficit and arrival by ambulance versus private vehicle. Patients arriving in the first 60 minutes more frequently received intravenous thrombolytic therapy than those arriving in 61 to 180 minutes (27.1 versus 12.9 percent), but their door-to-needle time was longer (90.6 versus 76.7 minutes).

"These findings support sustained public education efforts to increase the proportion of patients arriving within the first 30 to 60 minutes after stroke onset by emphasizing the recognition of stroke symptoms and the immediate activation of 911. These data also encourage reinvigorated hospital performance improvement activities to shorten door-to-needle times in patients who present in the golden hour," the authors conclude.

The program that generated the data used in the study is supported in part by grants from Pfizer and the Merck-Schering Plough Partnership. Several co-authors disclosed financial relationships with pharmaceutical or medical device companies.

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