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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
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Geographical differences in thrombolysis treatment for acute ischaemic stroke
Kristin Busund1, Linn Hofsøy Steffensen2, Amalie Hauan3
1Øyeavdelingen, Universitetssykehuset Nord-Norge, Tromsø.
Summary
Patients living further from the hospital receive faster intravenous thrombolysis (IVT) less often for acute ischaemic stroke. This delay in treatment access impacts outcomes, highlighting the need for decentralized IVT services.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Timely administration of intravenous thrombolysis (IVT) is critical for improving functional outcomes in acute ischaemic stroke.
- Geographical distance to healthcare facilities can influence patient access to time-sensitive treatments like IVT.
- The University Hospital of North Norway (UNN) in Tromsø serves a region with varying distances from its primary facility.
Purpose of the Study:
- To evaluate the impact of patient distance from the hospital at symptom onset on the accessibility and timeliness of IVT for acute ischaemic stroke.
- To compare IVT rates and treatment delays between urban and rural patient cohorts.
Main Methods:
- A prospective quality study involving 231 patients admitted with acute ischaemic stroke to UNN between January 1, 2019, and December 31, 2019.
- Patients were categorized into urban (≤30 minutes transport time) and rural (>30 minutes transport time) cohorts based on road travel time to the hospital.
- Data on patient characteristics, IVT administration, functional status, and prehospital timelines were collected from the Norwegian Stroke Registry and the Acute Medical Information System (AMIS).
Main Results:
- Of 231 patients, 108 were from urban areas and 123 from rural areas.
- The proportion of patients receiving IVT was significantly higher in the urban cohort (38%) compared to the rural cohort (23%).
- The urban cohort received IVT on average 75 minutes sooner than the rural cohort, with urban patients having better pre-onset functional status.
Conclusions:
- Patients located further from the hospital at symptom onset experience less frequent and more delayed IVT administration.
- This disparity in access to time-critical stroke treatment is associated with a lower likelihood of favorable outcomes.
- Decentralizing IVT services may enhance treatment provision and improve outcomes for rural ischaemic stroke patients.
