Competing interests: None identified.
Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in acute ischaemic stroke: An audit of current practice and clinical outcomes
Article first published online: 16 AUG 2013
© 2013 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.
Australian Journal of Rural Health
Volume 21, Issue 4, pages 203–207, August 2013
How to Cite
Williams, J. M., Navin, T. J., Jude, M. R. and Levi, C. R. (2013), Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in acute ischaemic stroke: An audit of current practice and clinical outcomes. Australian Journal of Rural Health, 21: 203–207. doi: 10.1111/ajr.12038
- Issue published online: 16 AUG 2013
- Article first published online: 16 AUG 2013
- Manuscript Accepted: 9 FEB 2013
- Health Education and Training Institute
- emergency medicine;
- thrombolytic therapy
This audit of activity reports on current rates of recombinant tissue plasminogen activator (rt-PA) use within specialised stroke care units in rural New South Wales (NSW). It measures stroke onset-to-treatment time and morbidity outcomes for patients treated with rt-PA and aims to establish the safety and effectiveness of rt-PA use in rural NSW.
Design, setting and participants
Medical records reviews of patients admitted with acute ischaemic stroke at two rural NSW hospitals between 1 July 2008 and 30 June 2010.
Main outcome measures
Treatment with rt-PA, morbidity scores 5 days post-stroke or discharge, incidence of intracranial haemorrhage and mortality rate 6 months post-stroke were recorded. Treatment protocol violations were assessed and time to treatment from stroke onset and hospital admission.
Of 605 patients admitted with acute ischaemic stroke, 20 (3.3%) received rt-PA treatment. Of these two, 10% had symptomatic intracranial haemorrhage and one died within 6 months. Morbidity scores for those treated with rt-PA were similar to those not treated. The median onset-to-needle time was 2 hours and 34 min, and the median door-to-needle time was 1 hour and 40 min. There were no treatment protocol violations.
Recombinant tissue plasminogen activator can be delivered in rural Australian hospitals in a timely manner within recommended implementation guidelines. Acute stroke thrombolytic services in rural Australian facilities had comparable outcomes to metropolitan facilities. Small numbers of thrombolysed patients prevented a validation study of the well-defined outcome benefits from rt-PA. The need for ongoing data collection in regional settings is supported.