[Influence of the experience and of out-of-hospital stroke code in thrombolytic treatment of acute stroke]. / Influencia de la curva de aprendizaje y del código ictus extrahospitalario en el tratamiento trombolítico del ictus agudo.

ABSTRACT

INTRODUCTION: We present the experience for thrombolytic treatment using recombinant tisular plasminogen activator (rt-PA) at a university hospital. We analyze the influence of individual and collective acquired experience and of the activation of an out-of-hospital stroke code (OSC) on the delays to onset of treatment, number of patients treated and outcome. METHOD: Prospective register of patients with ischemic stroke treated with rt-PA within the period 1/2004- 12/2006. Comparison of results between patients treated during the three years of study and based on the individual experience of the neurologist who applies the treatment and on the patients treated with or without activation of OSC. RESULTS: A total of 87 patients were treated (mean age 66.6 +/- 13.7). Door-to-needle time was 79 +/- 21 min in 2004, 64 +/-22 in 2005 and 63 +/- 26 in 2006 (p=0.003). Experienced neurologists started thrombolysis sooner (door-to-needle time 62 +/- 22 min vs 75 +/- 27, p=0.03). Activation of the ESC reduced door-to-needle time (53 +/ 17 min vs 65 +/- 21; p=0.032) and door-to-computed tomography scan time (21 +/- 10 min vs 29 +/-24; p=0.016). There were no differences in outcome in the different groups. CONCLUSIONS: Individual and collective acquired experience and the activation of an OSC can lower in-hospital delays. This contributes to increasing the number of patients eligible for thrombolysis. Thrombolytic therapy is safe and effective even when it is applied by inexperienced neurologists if strict guidelines are followed.