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Recombinant tissue plasminogen activator ( rt‐PA ) utilisation by rural clinicians in acute ischaemic stroke: An audit of current practice and clinical outcomes
Author(s) -
Williams Jocelyn M.,
Navin Tina J.,
Jude Martin R.,
Levi Christopher R.
Publication year - 2013
Publication title -
australian journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.48
H-Index - 49
eISSN - 1440-1584
pISSN - 1038-5282
DOI - 10.1111/ajr.12038
Subject(s) - medicine , thrombolysis , stroke (engine) , recombinant tissue plasminogen activator , audit , acute stroke , tissue plasminogen activator , emergency medicine , ischaemic stroke , incidence (geometry) , ischemic stroke , ischemia , mechanical engineering , management , myocardial infarction , modified rankin scale , engineering , economics , physics , optics
Objective This audit of activity reports on current rates of recombinant tissue plasminogen activator ( rt‐PA ) use within specialised stroke care units in rural N ew S outh W ales ( 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 J uly 2008 and 30 J une 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.