on January 29, 2009
Published online before print January 29, 2009, doi: 10.1161/STROKEAHA.108.527770
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Submitted on June 19, 2008
From the Department of Neurology (A.L.F., L.T.C., J.-M.L., A.M.N.), the Program in Occupational Therapy and Department of Radiology (L.T.C.), the Department of Emergency Medicine (D.K.T.), and the Department of Emergency Services Barnes-Jewish Hospital (J.A.W.), Washington University School of Medicine, St. Louis, Mo. * To whom correspondence should be addressed. E-mail: nassiefa{at}wustl.edu.
Background and Purpose—The decision to administer tPA to acute stroke patients is frequently made by stroke attendings or fellows, but placing residents in this position may make tPA delivery more efficient. Methods—Beginning in 2004, we instituted a resident-based acute stroke protocol placing neurology residents in decision-making roles. Time-intervals, symptomatic hemorrhage rate, and discharge locations were prospectively collected and compared between two epochs, before and after 2004. Results—59 acute ischemic stroke patients were treated with tPA before protocol initiation (1998 to 2002), while 113 patients were treated after protocol initiation (2004 to 2007). The average door-to-needle and onset-to-needle times were significantly shorter after initiation of the resident-based protocol (81 versus 60 minutes [P<0.001] and 138 versus 126 minutes [P<0.05]), respectively. Symptomatic hemorrhage rate (5.1% versus 3.5%) and favorable discharge location (68% versus 76%) did not differ between the two time periods. Conclusion—A resident-driven tPA protocol, with formal training and quality control, is safe and efficient.
Revised on July 26, 2008
Accepted on August 5, 2008
Resident-Based Acute Stroke Protocol Is Expeditious and Safe
Andria L. Ford MD;
Key words: acute stroke • tPA • thrombolytic • stroke protocol • resident