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An analysis of outcomes of emergency physician/department-based thrombolysis for stroke
  1. A P Volans
  1. Correspondence to A P Volans, Emergency Department, Scarborough Acute Trust, Woodlands Drive, Scarborough, North Yorkshire YO12 6QL, UK; andrew.volans{at}


Background Stroke thrombolysis is strongly supported as an effective therapy for selected cases of early stroke. The absence of 24 h stroke specialists in district general hospitals (DGHs) has led to the suggestion that regional hyper-acute stroke centres should be developed. This paper describes a cooperative model that uses the skills already present in a DGH to deliver a thrombolysis service initiated in the emergency department by the emergency physicians, and describes the outcomes of that service in comparison with the SITS-MOST trial.

Method The outcomes of all stroke patients thrombolysed at Scarborough DGH from 2004 to January 2009 were reviewed. Outcome was defined using a three-part scale. Data at Scarborough DGH were compared with data from the SITS-MOST European-wide study of stroke thrombolysis.

Results Data were available for 98 of 110 patients thrombolysed during the study period. Fifty (51%) had a good outcome, seven (8%) had partial resolution of their symptoms, and 41 (42%) showed no improvement or deterioration. These outcomes were comparable to those in the European database.

Conclusion Stroke thrombolysis can be effectively delivered in a non-specialist (a non-hyper-acute stroke centre) DGH in the UK. An audit of cases completed describes complications seen.

  • Stroke thrombolysis
  • emergency department
  • outcomes
  • forensic legal medicine
  • epilepsy
  • neurology
  • anaphylaxis allergy
  • stroke, headache
  • critical care transport
  • major incident planning
  • advanced practitioner
  • trauma

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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