Editors' note: Effects of increasing IV tPA-treated stroke mimic rates at CT-based centers on clinical outcomes
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In “Effects of increasing IV tPA-treated stroke mimic rates at CT-based centers on clinical outcomes,” the authors determined that hub centers using MRI prior to thrombolysis had lower stroke mimic rates than their spoke facilities that used only CT prior to thrombolysis. They were not able to determine whether this difference was due to the imaging modality employed or the initial clinical evaluation, done by a vascular neurologist at the hub center and an emergency medicine physician at the spoke facilities, with the vascular neurologists consulting via telephone. Dr. Uchino performed a retrospective study looking at the same question at his own hub and spoke hospitals, except that all facilities used CT only before thrombolysis. Initial clinical evaluation was also done by a vascular neurologist at the hub center and an emergency physician at the spoke hospitals. He found a significantly higher proportion of stroke mimics among patients who were thrombolyzed at the spoke facilities, indicating that at least some of the difference seen in the original study was due to the physician who performed the initial clinical evaluation. Authors Hsia and Burton agree that while there are many factors that may contribute to higher rates of stroke mimics being thrombolyzed, including the emphasis placed on reducing door-to-needle times, the thrombolysis of some stroke mimics may be due to the limitations of vascular neurology consultations available only via telephone.
In “Effects of increasing IV tPA-treated stroke mimic rates at CT-based centers on clinical outcomes,” the authors determined that hub centers using MRI prior to thrombolysis had lower stroke mimic rates than their spoke facilities that used only CT prior to thrombolysis. They were not able to determine whether this difference was due to the imaging modality employed or the initial clinical evaluation, done by a vascular neurologist at the hub center and an emergency medicine physician at the spoke facilities, with the vascular neurologists consulting via telephone.
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- Copyright © 2018 American Academy of Neurology
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