Abstract
To promote rt-PA therapy, the medical staff in our hospital began to participate in Immediate Stroke Life Support (ISLS) in April 2007, and we have accepted acute stroke patients transported on Prehospital Stroke Life Support (PSLS) system since October 2007. The aim of this study was to evaluate the effects of introducing the PSLS and ISLS systems on intravenous rt-PA therapy. We determined the time elapsed before initiation of rt-PA therapy between an early period (May 2006–December 2007) and a later period (January 2008–December 2008). Additionally, the correlation between National Institutes of Health Stroke Scale (NIHSS) and Kurashiki Prehospital Stroke Scale (KPSS) neurological assessments by emergency medical service paramedics was investigated. The rate of therapeutic efficacy (defined as improvement from the baseline score on the NIHSS by 4 or more points 24 hours after the administration of rt-PA) was 61.5%, and the modified Rankin Scale (mRS) score of 0–1 was 36% at discharge. When compared to the early baseline period, the in-hospital time (latency to rt-PA administration) was significantly shortened (early period: 93 min., later period: 76 min., p‹0.005) and the total number of patients receiving rt-PA was increased in the later period (patients with rt-PA administration/all admissions of acute ischemic stroke: 27/208, 13.0%). A positive relationship was discovered between NIHSS and KPSS score (r=0.78, p‹0.001). Both a reduced time to rt-PA therapy and an increased number of patients receiving rt-PA revealed an additive effect of PSLS/ISLS systems.
