Outcome of Chumphae Stroke Fast Track guildeline and intravenous thrombolytic therapy for acute ischemic stroke patients

Abstract

Background : Intravenous thrombolytic therapy (recombinant tissue plasminogen activator ;rt-PA) in ischemic stroke patient within the first 4.5 hours for all patients who do not have contraindications for systemic thrombolysis is most important treatment. The chief benefit of thrombolysis is improved final functional outcome through reperfusion salvage of threatened tissue. Objective : We present outcome of stroke fast track guildeline for acute ischemic stroke patient with intravenous thrombolytic therapy (rt-PA) in Chumphae hospital and compare the results with previously published data. Setting : Chumphae hospital and the hospital network. Method : A retrospective descriptive study was done in 372 patients with acute onset symptoms of stroke in Chumphae between October 2015 and September 2016. The main outcome measure were IV thrombolytic treatment rate, initial National Institutes of Health Stroke Scale (NIHSS) score, door to needle time, onset to treatment time, door to CT time, door to LAB time, intracerebral hemorrhage and inhospital mortality after intravenous thrombolytic therapy, rate of physical therapeutic programm before discharge from hospital. Result : A 372 patients were present with symptoms of stroke. 110 patient were ischemic stroke (72.85%) and recruited to Stroke Fast Track guildeline. Forty patients (36.36%) were received IV thrombolytic therapy. The mean of initial National Institutes of Health Stroke Scale (NIHSS) score before thrombolytic therapy was 8, 95% of patients had been used mean door to needle time less than 30 minutes, mean onset to treatment time was 145.70 minutes, 77.95% of patients had been used mean door to CT time less than 30, 95% of patients had been used mean door to LAB time less than 30 minutes, intracerebral hemorrhage was 7.5% and no inhospital death after onset. All most patients had recieved physical therapeutic program before discharge from hospital. These outcomes are same as previously published data from other hospital, such as Buriram Hospital, King Chulalongkorn Memorial Hospital, Chiangmai neurological hospital and Srinagarind Hospital. Conclusion : The stroke patients were treated by Chumphae Stroke Fast Track guideline and intravenous thrombolytic therary in Chumphae hospital was effectively as the standards. Empowerment of network and Stroke alert promotion in community can reproduce the experience and outcome that should improve the rate of thrombolytic therapy.