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Updated: Jun 27, 2026
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
[Ten years' experience at a major stroke center]
T Konatschnig1, A Knöll, A Hug
1Neurologische Klinik der Ruprecht Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland. Thomas.Konatschnig@med.uni-heidelberg.de
Insights
Reducing prehospital delay significantly increased the number of stroke patients eligible for acute intravenous thrombolysis. This improvement was achieved without changes in patient demographics or stroke severity over a decade.
Area of Science:
- Neurology
- Public Health
Background:
- 1,300 stroke patients treated annually at University Hospital Heidelberg.
- Data collected prospectively from 1996-2006.
- Focus on changes in patient population and thrombolysis suitability.
Purpose of the Study:
- Analyze changes in stroke patient demographics and treatment from 1996 to 2006.
- Evaluate the impact of prehospital delay on intravenous thrombolysis eligibility.
- Assess trends in acute stroke care.
Main Methods:
- Retrospective analysis of prospectively collected patient data.
- Inclusion of basic demographic and clinical data (age, sex, stroke type, NIH Stroke Scale).
- Detailed data on prehospital and in-hospital delays, and thrombolysis treatment parameters.
Main Results:
- No significant changes in total stroke patient numbers or median stroke severity (NIH Stroke Scale) from 1996 to 2006.
- Proportion of patients arriving within 3 hours of symptom onset increased from 12.1% to 21.9%.
- Intravenous thrombolysis treatment increased to 10.1% of ischemic stroke patients, representing 39% of those with cerebral infarction arriving within the critical 3-hour window.
Conclusions:
- Sociodemographic data of stroke patients remained stable during the study period.
- Consistent reduction in prehospital delay was key to increasing the number of patients receiving acute intravenous thrombolysis.
- Improved patient flow and timely intervention enhance acute stroke treatment outcomes.
Background:
About 1,300 stroke patients from a primarily rural area are treated each year at the Department of Neurology of the University Hospital of Heidelberg, Germany. Demographic and treatment data of all stroke patients there were prospectively collected. In a retrospective study we report on the changes in this patient population from 1996 to 2006, with special consideration of those suitable for intravenous thrombolysis.
Methods:
For all stroke patients the basic data were collected--age, sex, type of stroke (transient ischemic attack, stroke, or intracerebral hemorrhage), NIH Stroke Scale, duration between symptom onset and hospital arrival, delay between arrival and first doctor's contact, patient's further whereabouts, and for patients treated by iv thrombolysis, start of treatment and dosage.
Results:
There were no changes in the total number of stroke patients and median stroke severity, according to the NIH Stroke Scale, from 1996 to 2006. The proportion of stroke patients admitted within the first 3 h after symptom onset increased from 12.1% (1996) to 21.9% (2006). Thus we managed to treat 10.1% of all our ischemic stroke patients with iv thrombolysis, which means 39% of those patients with cerebral infarction arriving within 3 h.
Discussion:
During the study period there were no significant changes in the patients' sociodemographic data. By consistent reduction of prehospital delay, the number of stroke patients that could be treated acutely by intravenous thrombolysis was increased.
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