[Impact of a stroke-unit on rtPA use in a community hospital: a 3-year prospective study]

Although intravenous thrombolysis has been used for ischemic strokes since 2004 in our community hospital located in Pau (southwest of France), a specifically dedicated stroke-unit (SU) was created only recently in June 2010. We decided to collect prospective data to compare the use and efficacy of intravenous thrombolysis before and after the opening of this dedicated stroke unit.

Stroke patients with internal carotid artery territory involvement treated with intravenous thrombolysis were compared between two similar periods. The first period (called pre-SU period) stretched from January 2009 to June 2010. The second period (called SU period) stretched from June 2010 to October 2011. We collected prospectively all morbidity/mortality data as well as a modified Rankin score (mRS) three months later.

During the pre-SU period, 21 strokes were treated with a mean NIHSS score of 15. Three months later, the mRS score was less than or equal to 2 for five patients, and greater than or equal to 3 for 12. A total of four patients died. In addition, two-thirds of patients (14 of 21) had suffered from notable complications at the initial phase of their stroke. During the SU period, 27 strokes were treated with a mean NIHSS score of 14. At 3 months, the mRS score less than or equal to 2 for 15 patients, and greater than or equal to 3 for nine other patients. A total of three patients died. During this second period, less than 50% of the patients (13 of 27) were not affected by any complication at the initial phase. Statistically, the results also show a better short-term (24 hours with NIHSS) and medium-term (3 months with NIHSS and mRS) clinical outcome for patients treated during the SU period.

Instituting a dedicated stroke-unit helped improve outcome after ischemic strokes treated by intravenous thrombolysis. It also increased the number of patients and reduced the complications at the initial phase.