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Journal of Neurology

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01.04.2013 | Review

The chain of care enabling tPA treatment in acute ischemic stroke: a comprehensive review of organisational models

verfasst von: Maarten M. H. Lahr, Gert-Jan Luijckx, Patrick C. A. J. Vroomen, Durk-Jouke van der Zee, Erik Buskens

Erschienen in: Journal of Neurology | Ausgabe 4/2013

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Abstract

Protracted and partial implementation of treatment with intravenous tissue plasminogen activator (tPA) within 4.5 h after acute stroke onset results in potentially eligible patients not receiving optimal treatment. The goal of this study was to review the performance of various organisational models of acute stroke care delivery, and subsequent attempts to improve implementation of tPA treatment. Publications comprehensively reporting on organisational models to improve implementation of i.v. tPA treatment of acute ischemic stroke patients were selected. The efficacy of organisational models was assessed using process outcome measures: thrombolysis rates, time-dependent operational endpoints (time delays), functional outcomes: safety (rate of symptomatic intracranial hemorrhage, mortality rates) and clinical outcome at 90 days (modified Rankin Scale). Fifty-eight published studies assessing organisational models were identified. Four dominant models of acute stroke care delivery were discerned, i.e., primary and comprehensive stroke centres, telemedicine, and the mobile stroke unit. Performance reported for these models suggest a large variation in administration of thrombolytic therapy (0.7–30 %). Time delays and functional outcomes found varied considerably, just like safety and mortality (0.0–11.5 %, and 3.4–31.9 %, respectively). These findings suggest that improving organisational models for tPA treatment may improve acute stroke care. However, implementation may be hampered by regional variation in acute stroke care capacity, expertise, and a fragmented approach towards organising stroke care.

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Titel: The chain of care enabling tPA treatment in acute ischemic stroke: a comprehensive review of organisational models
verfasst von: Maarten M. H. Lahr
Gert-Jan Luijckx
Patrick C. A. J. Vroomen
Durk-Jouke van der Zee
Erik Buskens
Publikationsdatum: 01.04.2013
Verlag: Springer-Verlag
Erschienen in: Journal of Neurology / Ausgabe 4/2013
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-012-6647-7

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