Recombinant tissue plasminogen activator ( rt‐PA ) utilisation by rural clinicians in acute ischaemic stroke: An audit of current practice and clinical outcomes

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.