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Updated: May 4, 2026

Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Prehospital factors determining regional variation in thrombolytic therapy in acute ischemic stroke
Maarten M H Lahr1, Patrick C A J Vroomen, Gert-Jan Luijckx
1Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Background:
Treatment rates with intravenous tissue plasminogen activator vary by region, which can be partially explained by organizational models of stroke care. A recent study demonstrated that prehospital factors determine a higher thrombolysis rate in a centralized vs. decentralized model in the north of the Netherlands.
Aim:
To investigate prehospital factors that may explain variation in thrombolytic therapy between a centralized and a decentralized model.
Methods:
A consecutive case observational study was conducted in the north of the Netherlands comparing patients arriving within 4·5 h in a centralized vs. decentralized stroke care model. Factors investigated were transportation mode, prehospital diagnostic accuracy, and preferential referral of thrombolysis candidates. Potential confounders were adjusted using logistic regression analysis.
Results:
A total of 172 and 299 arriving within 4·5 h were enrolled in centralized and decentralized settings, respectively. The rate of transportation by emergency medical services was greater in the centralized model (adjusted odds ratio 3·11; 95% confidence interval, 1·59-6·06). Also, more misdiagnoses of stroke occurred in the central model (P = 0·05). In postal code areas with and without potential preferential referral of thrombolysis candidates due to overlapping catchment areas, the odds of hospital arrival within 4·5 h in the central vs. decentral model were 2·15 (95% confidence interval, 1·39-3·32) and 1·44 (95% confidence interval, 1·04-2·00), respectively.
Conclusions:
These results suggest that the larger proportion of patients arriving within 4·5 h in the centralized model might be related to a lower threshold to use emergency services to transport stroke patients and partly to preferential referral of thrombolysis candidates.
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