Pace of Progress in Stroke Thrombolysis
Are Hospitals Running To Stand Still?
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Stroke is a time-sensitive medical emergency and a leading cause of disability in the United States. Therapies to halt and even reverse ischemic injury to the brain, such as intravenous tissue-type plasminogen activator (tPA), are available, but the systems to deliver them rapidly have not been optimized to ensure timely treatment of as many eligible patients as possible. Although ≈40 000 to 50 000 acute ischemic stroke patients per year receive tPA,1,2 benefits from the drug are not simply related to receiving it or not but rather are closely linked to time from onset to treatment.3,4 Delays to treatment lead to more disability because every additional 5 minutes is tantamount to the permanent loss of nearly 10 million brain cells.5 National guidelines and quality measures have, therefore, emphasized speed of stroke thrombolysis, focusing on the time between patient arrival to the hospital and tPA administration, also known as door-to-needle (DTN) time.6,7 Alarmingly, recommendations that hospitals evaluate acute ischemic stroke patients and administer tPA within 60 minutes of a patient’s arrival to the emergency department have existed since the original National Institutes of Neurological Disorders and Stroke tPA trial.8 Despite this, as the first decade of the new millennium closed, US hospitals were not meeting this goal in a majority of patients.
See Articles by Xian et al and Kamal et al
In response to lagging performance nationwide, the first phase of the American Stroke Association Target: Stroke campaign began in January 2010 and provided Get With The Guidelines-Stroke participating hospitals best practice strategies and supporting resources to …