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(Stroke. 2006;37:2935.)
© 2006 American Heart Association, Inc.

Original Contributions

An Expedited Code Stroke Protocol Is Feasible and Safe

Justin A. Sattin, MD; Scott E. Olson, MD; Lin Liu, PhD; Rema Raman, PhD Patrick D. Lyden, MD

From Departments of Neurosciences (J.A.S., S.E.O., R.R., P.D.L.) and Family and Preventive Medicine (L.L., R.R.), University of California, San Diego School of Medicine, San Diego, Calif; Neurology Service (P.D.L.), Veterans Administration Medical Center, San Diego, Calif.

Correspondence to Dr Patrick Lyden, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail plyden{at}ucsd.edu

Background and Purpose— Stroke recovery critically depends on timely reperfusion. In July 2003, we set a benchmark onset-to-treatment time of 2 hours and instituted an expedited code stroke protocol to accomplish this. We aim to show that the protocol is feasible and safe.

Methods— The expedited protocol includes: Benchmark onset-to-treatment within 2 hours; in-person triage of all code stroke patients; unmixed tissue plasminogen activator at the bedside during evaluation; no delays pending coagulation tests, chest x-ray, or stool guiac unless specifically indicated; and no delays pending formal CT interpretation or written consent.

Results— Between July 2003 and June 2005, we evaluated 781 patients and treated 103 of 781 (13.2%) with intravenous recombinant tissue plasminogen activator within 3 hours. Of these, we treated 49 of 103 (47.6%) within 2 hours of symptom onset, and 54 of 103 (52.4%) between 2 and 3 hours. The overall risk of symptomatic intracerebral hemorrhage was 4 of 103 (3.9%; 95% CI, 1.1%, 9.6%), and not significantly different from 6.4% (P=0.42). The hemorrhage risks in those treated within 2 hours of symptom onset and those treated between 2 and 3 hours were not significantly different from each other or from 6.4%.

Conclusions— The expedited code stroke protocol is feasible and appears safe. Further study is warranted to confirm its safety and determine whether it results in better clinical outcomes.

Key Words: acute care • health resources/utilization • stroke management • thrombolysis

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