Telephonic guidance of systemic thrombolysis in acute ischemic stroke: Safety outcome in rural hospitals

Objectives: To determine the safety of telephonic guidance for use of intravenous recombinant tissue plasminogen activator (IV rtPA) in rural hospitals. Patients and methods: We performed a retrospective survey of 123 consecutive patients treated with IV rtPA for acute ischemic stroke (AIS) in rural hospitals between November 2003 and September 2006 and subsequently transferred to a tertiary medical center. Selection for treatment was performed by a stroke neurologist who conducted a structured telephone interview of the requesting physician. Primary outcome measures included symptomatic intracerebral hemorrhage (ICH) and in-hospital mortality. Results: Elapsed time (ET) from stroke onset to community hospital arrival was 54 ± 30 min. ET from stroke onset to tPA bolus was 133 ± 37 min. Three patients (2.5%) had symptomatic ICH, 11 (9%) had asymptomatic ICH, 9 patients (7.5%) died. Mean length of stay was 4 ± 3 days; 47% were discharged to their homes. Mean ET from stroke onset to rtPA dosage did not differ significantly from the active treatment group of the NINDS rtPA Stroke Study. Prevalence of symptomatic ICH and mortality were lower in our population. Conclusion: We conclude that telephonic guidance of rtPA treatment is safe, practical, and effective in overcoming barriers for optimal care of AIS in rural communities.