Neurology -- Correspondence for de la Ossa et al., 70 (15) 1238-1243

Correspondence published:

Influence of the stroke code activation source on the outcome of acute ischemic stroke patients: David S. Whitcomb, MD (14 July 2008)

Reply from the author: Natalia Pérez de la Ossa (14 July 2008)

Influence of the stroke code activation source on the outcome of acute ischemic stroke patients 14 July 2008

David S. Whitcomb, MD
1521 Johnson Ferry Rd., #135, Marietta, GA 30062
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Re: Influence of the stroke code activation source on the outcome of acute ischemic stroke patients

whitcombds{at}pol.net David S. Whitcomb, MD

The statistics on the effects of stroke protocol by Dr. Perez de la Ossa et al. seemingly support the benefit of TPA. This is due to a tight correlation between its use in the three groups and percentages which showed neurologic improvement: Group A (27% and 31.2%); Group B (54% and 54.4%); and Group C (46% and 48.3%). [1]
However, the pooled data on outcomes show a less impressive result. According to my calculations, of the 157 patients who did not receive TPA, 48% had a "good outcome," while the 105 patients who did receive TPA, 43% had good outcome. Stroke protocol may have benefited these patients, but the specific role of TPA is less clear in this data.
Reference
1. Perez de la Ossa N, Sanchez-Ojanguren J, Palmoeras E et al. Influence of the stroke code activation source on the outcome of acute ischemic stroke patients. Neurology 2008;70:1238.
Disclosure: The author has no disclosures.

Reply from the author 14 July 2008

Natalia Pérez de la Ossa,
Hospital Universitari Germans Trias i Pujol
Carretera de Canyet s/n. 08916 Badalona, Spain
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Re: Reply from the author

35783npo{at}comb.es Natalia Pérez de la Ossa

In our article, we studied the influence of mode of transfer to the Stroke Center on the outcome of acute stroke patients. [1] Modes of transfer included: community hospitals (A), emergency medical services (EMS, B), or the emergency department of the stroke center (C).
We found a higher proportion of patients with neurologic improvement at 24h in groups B and C. As Dr. Whitcomb suggested, the rate of neurologic improvement at 24h was similar to the rate of tPA administration. Thrombolytic treatment was related to early neurological improvement observed in 61.5% of patients treated with tPA and in 29.1% of those not treated (p<0.001). However, we suggested that the benefit of the way of transfer to the Stroke Center on the outcome at short term is not only explained by tPA administration but also by a shorter delay until neurologic attention.
The effect of tPA on the clinical outcome at discharge is less evident in our study. Good outcome at discharge was observed in 43% of patients treated with tPA and 48% of patients not treated. However, baseline characteristics of these two groups are not comparable because stroke severity was lower in patients not treated. An NIHSS score lower than 5 was observed in 19% of patients treated with tPA and 50% of those not treated. This condition conferred a higher probability of good outcome. Fifty-eight% of patients with good outcome at discharge had a minor stroke compared to 21% of patients in the group with poor outcome.
According to the objectives of our study, we included all the stroke patients arriving via Stroke Code activation, conferring a heterogenic group of patients. Thus, the design of our study is not adequate to study the benefit of tPA administration on the clinical outcome, but to analyze the influence of the way of transfer to the Stroke Center and the delay until specialized attention was conferred.
Disclosure: The author has no disclosures.