JC: Time is brain…., calling #FOAMagitators. St.Emlyn’s

Streamlining of prehospital stroke management: the golden hour.

If you have been happily playing with #FOAM for the last year or two then you must have come across the many excellent articles on the use of thrombolysis in stroke.

Ed – what do you mean you’ve missed the debate!!

Seriously? Well I suppose it’s possible that you may have missed the superb contributions that have exposed the questions and concerns about the efficacy and fair reporting of trials looking at stroke thrombolysis. If you’ve missed the debate then I would strongly recommend that you have a look at the following…

There are many more out there and if you want to hear a fantastic review of all this then keep your eyes out for Domnhall’s talk from SMACC2013 when it is released. That was a fantastic summary and I hope it will make an appearance soon.

So, why am I talking about this if there has already been many questions in the #FOAM community already? Well, the Lancet has released a new article in the online first section that makes claims and suggests therapies that I would love my esteemed colleagues to review. The paper looks at streamlining prehospital care to deliver patients with stroke to a centre available to deliver thrombolysis as quickly as possible. This is analogous to the changes we have seen around cardiac care to deliver patients to thrombolysis, and no PCI as quickly as possible. In this study the argument for rapid transfer is predicated on the assumptions that thrombolysis is ‘state of the art’ and that the NNT for a positive outcome is 4.5 if thrombolysis is administered within 1.5 hours (NNT of 9 if 1.5-3 hours post symptom onset).

Now, just to redress the balance a little then you might also want to whizz over to EMCrit and listen to Scott’s podcast on the optimisation of processes for the delivery of stroke thrombolysis in hospital. To be fair Scott does not personally endorse it, but does say that if your institution decides to do this then do it well, and this is a way of delivering a slick door to needle time.

Does this matter? Well arguably yes. The proposals set out in the paper will require investment in time and money, and at a time of austerity we really do need to make sure that our health pounds are spent wisely.

So, if this area interests you then please do have a read, and if you feel the need it’s worth mentioning  that the Lancet has a quite vigorous correspondence section………

lancet stroke paper

 

 

 

 

 

 

 

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3 Comments

  1. Simon Carley (Post author)

    …and by pure co-incidence this appears via twitter today.

    http://emj.bmj.com/content/early/2013/06/13/emermed-2012-201543.full.pdf

    More on moving patients quickly to hospital following stroke/TIA.

    S

    Reply
  2. Jo Deverill

    Well the Golden Hour for trauma was a myth, out of which emergency and retrieval medicine did quite well. Now other specialties want to chase 60-minute rainbows. Should we be surprised?

    Reply
  3. roger harris

    mmmmmmmmmm? We don’t use IV thrombolysis much as we tend to go straight to INR and Clot retreival / intra-arterial urokinase. Not confident of this approach either but feel better about INR localised urokinase than systemic thrombolysis?

    Reply

Thanks so much for following. Viva la #FOAMed

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