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Management of stroke in Auckland Hospital in 1996
A J Charleston1, P A Barber, P Bennett
1Auckland Hospital.
Insights
This study reviewed stroke management in Auckland, finding increased CT scanning rates and limited suitability for tissue plasminogen activator (t-PA) treatment. Routine aspirin use is feasible for acute stroke patients.
Area of Science:
- Neurology
- Public Health
Background:
- Stroke management practices in Auckland were last reviewed in 1991/92.
- Current stroke care requires evaluation against established benchmarks.
Purpose of the Study:
- To review current stroke management at Auckland Hospital.
- Compare contemporary stroke care with 1991/92 practices.
- Assess patient eligibility for aspirin or tissue plasminogen activator (t-PA) therapy.
Main Methods:
- Retrospective case note review of acute stroke patients (over 15 years) excluding subarachnoid haemorrhages.
- Data collected on presentation, diagnostic imaging, and initial treatments.
Main Results:
- 184 stroke events were analyzed; median time to hospital arrival was 3 hours.
- Computed tomography (CT) scans increased to 88% from 42% in 1991/92.
- Only 10% of patients received CT within 3 hours; 36% of ischemic stroke patients received aspirin.
Conclusions:
- Significant increase in CT scanning rates for stroke patients.
- Fewer than 5% of stroke patients are candidates for t-PA therapy.
- Routine aspirin administration within 48 hours is achievable without major management changes.
Aims:
To review the management of stroke in Auckland Hospital; compare current management with practice in Auckland in 1991/92; and determine how many patients may be suitable for treatment with aspirin or tissue plasminogen activator (t-PA).
Methods:
Retrospective review of case notes for all patients over the age of 15 years presenting during four months in 1996 with symptoms and signs of an acute stroke. Subarachnoid haemorrhages were excluded.
Results:
There were 184 stroke events (135 ischaemic strokes, 26 intracerebral haemorrhages, 23 unspecified strokes) in 179 patients. The time between the onset of symptoms and arrival in hospital was available for 109 patients: the overall median time was three hours, two hours for intracerebral haemorrhages, three hours for ischaemic strokes, four hours for unspecified strokes. Most patients (78%) were admitted to a general medical ward. Only 10% of the patients managed on a non-neurological ward were referred to a neurologist. Computed tomography (CT) was obtained in 88% of the patients. The median time from the onset of symptoms to CT was 19 hours (11 hours for intracerebral haemorrhages, 21 hours for ischaemic strokes). Only 11 patients (10%) were scanned within three hours of the onset of symptoms. Of the 135 patients who had an ischaemic stroke, 36% were treated with aspirin and 6% with heparin in the first 48 hours. Thirty-two patients (17%) died in hospital, 87 (47%) returned home, 37 (20%) were transferred to a rest home or private hospital and 28 (15%) were transferred to other places.
Conclusions:
Compared with 1991, the rate of CT scanning after a stroke increased from 42% to 88%. At present, no more than 5% of all patients presenting with a stroke are suitable for consideration of treatment with t-PA. Routine treatment with aspirin in the first 48 hours could be achieved without other major changes in management.
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