Administration of tissue plasminogen activator for acute ischemic stroke in a rural Wisconsin hospital.

BACKGROUND: Tissue plasminogen activator (tPA) has provided a means to improve functional outcome of patients in the treatment of acute ischemic stroke.
METHODS: A retrospective chart analysis of ischemic stroke patients presenting from January 1995 to April 2007 to a particular hospital emergency department located in Ladysmith, Wis was conducted. The following factors were analyzed: door-to-tPA time, National Institutes of Health Stroke Scores (NIHSS) at admission and discharge, complication rates, disposition status, contraindications for receiving tPA, and specialties of physicians involved with stroke care.
RESULTS: During this time period, data was available for 108 patients diagnosed with ischemic stroke treated by physicians in 3 specialties (family practice, internal medicine, and emergency medicine). Of these patients, 18 were treated with tPA for an overall tPA administration rate of 16.2%. Onset of symptoms >3 hours prior to presentation was the most common contraindication to tPA administration. Door-to-tPA time was <60 minutes in 38.9% of cases. Patients treated with tPA were more likely to be discharged home and were less likely to expire within the following month; however, these differences did not reach statistical significance.
CONCLUSIONS: This study provides evidence that tPA can be safely administered in rural hospitals. Physicians working in rural emergency departments are able to diagnose and manage acute ischemic stroke within the guidelines established by the National Institute of Neurologic Disorders and Stroke (NINDS) without increased complication rates. Making tPA available in rural communities increases access to treatment and improves outcomes of patients with acute ischemic stroke.