Asad Mahmood, Muhammad Ashraf Sharif, Umar Zafar Ali, Muhammad Naeem Khan.
Time to hospital evaluation in patients of acute stroke for alteplase therapy.
Rawal Med J Jan ;34(1):43-6.

Objective To determine the time from onset of symptoms to hospital evaluation in patients with acute cerebro-vascular accidents to assess their eligibility for thrombolytic therapy. Method This cross sectional observational study was carried out from March 2004 to September 2004 at the Department of Neurology, Military Hospital, Rawalpindi on 95 patients with acute cerebro-vascular accident. Patients of stroke presenting in outpatient and emergency department within 72 hours of onset of symptoms were included in the study. NIH Stroke Scale (NIHSS) was assessed at time of admission and all had CT scan. Time of onset of symptoms, arrival at ER/OPD to time taken by resident or neurologist in attending patient and time of getting CT scan were noted. Results Of 95 patients, 20 (21%) were hemorrhagic and 75 (79%) were ischemic in nature. Median time of arrival to hospital from onset of symptoms was 12hrs (range 1-72hrs). Median time taken by resident to attend patient was 10min (range 2- 30mins). CT brain was performed within 90min (range 10-390) after arrival in hospital. Arrival within 3 hours of symptoms was seen in 16 (16.8%) patients, 13 (13.7%) patients within 6hrs while 66 (69.5%) patients after 6hrs. When adjusted for hospital delay and excluding the patients with hemorrhagic infarcts, 4 (4.2%) patients arrived within 3hrs and were most appropriate candidates for thrombolytic therapy. There were 11 (11.6%) patients assessed within 6hrs while the majority 80 (84.2%) came after 6hrs. Conclusions Most patients with stroke do not reach hospital in time and are not suitable candidates for thrombolytic therapy. (Rawal Med J 2009; 34: 43-46)

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