Attitudes and approaches to acute ischemic stroke in Wisconsin hospitals

Although acute stroke is a common presentation to an emergency room, the presentation of a patient with acute ischemic stroke, within a limited time window as an appropriate candidate for cerebral thrombolysis, is not common. In many of these patients, their candidacy can be improved through community education toward emergent transfer to an emergency room if they manifest symptoms of stroke. This would improve the "symptom-to-door" time. Another goal is to improve the recognition and approach of the hospital itself toward improving the "door-to-drug" time in appropriate patients. The obstacle to this second goal does not seem to be a nihilistic or evasive attitude on the basis of this study. Contrary to what was expected, enthusiasm for the use of cerebral thrombolysis was found in emergency physicians of all hospital categories, particularly of small remote hospitals. Instead, educational initiatives should focus on the facilitation of protocols for present and future ischemic stroke therapy, particularly in larger remote facilities that may be more self-dependent in their approach to acute stroke. An equally important focus should be toward more active participation by local neurologists who may be available for acute stroke care. Further, as this study demonstrates a correlation between the involvement of a local neurologist and the use of a stroke protocol, neurologists of non-tertiary facilities should be recruited to participate in these educational initiatives.