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Title: Barriers to thrombolysis in acute ischemic stroke: Experience from a Level 1 hospital in South Australia
Authors: Sreedharan, SE
Ravindran, J
Keywords: Neurosciences & Neurology
Issue Date: 2011
Citation: 16 ,1;17-23
Abstract: Objective: We studied the mean pre- and in-hospital delay of patients presenting with symptoms suggestive of acute stroke to assess the major barriers to thrombolysis. Methods: The study was a retrospective audit of all patients presenting to Emergency Department (ED) of Lyell McEwin Health Services, Adelaide, Australia with symptoms suggestive of acute cerebral ischemia in the year 2008. We assessed from ambulance and medical records the time of onset of symptoms, delay in presentation to ED, and in-hospital delay for evaluation and imaging. Results: Of 216 patients (Male=123, Female=93) with mean age 70.2 years, 103 (47.7%) presented within 3 hours of onset of symptoms. 42.85% of acute strokes presented within 1 hour 30 minutes. Only Australasian Triage Scale Level 1 and 2 had a positive association with completion of evaluation within 1 hour of arrival to ED. Patients with motor symptoms had less pre-hospital delay as compared with those presenting with other neurological symptoms. Arrival by ambulance or direct presentation to ED had no significant impact on pre-hospital delay. Conclusions: More number of patients are presenting to emergency services within 3 hours of onset of symptoms suggestive of acute stroke. However present triage system at ED often is inadequate in capturing all the strokes who are potential candidates for thrombolysis.
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