Auditing thrombolysis service for stroke at Mater Dei Hospital

Abstract

Thrombolysis for acute ischaemic stroke was introduced locally in October 2010. In 2012, the practice was audited to analyse the prevalence of inclusion and exclusion criteria for thrombolysis. Data about the local incidence of stroke, demographics and outcome was also obtained. All patients admitted to Mater Dei Hospital with a diagnosis of stroke over an 8 month period were recruited. Standard data collection sheets were used to obtain data. 251 patients were admitted with a confirmed stroke over the 8-month period. The time of onset was recorded in only 37.4% of cases. All patients had CT scanning of the brain within 24 hours of presentation, of which 70% were performed within 3 hours. The commonest 5 reasons for which thrombolysis was withheld were: presentation beyond 3 hours of symptom onset (73.7%), age over 80 years (29.9%), hypertension (13.9%), haemorrhagic stroke (13.1%) and minor deficit or rapid improvement (8.4%). Overall, only 4 patients (1.59%) were eligible for thrombolysis in our cohort, all of whom received the treatment. The study identified late presentation to A&E as the commonest exclusion criterion for thrombolysis. This prompted the launch of a stroke awareness ‘Act FAST’ campaign and increasing efforts to educate general practitioners to refer patients with acute stroke immediately. In addition, stroke pathway booklets were reviewed and simplified to increase their use. Since July 2013, the time window has been widened to 4.5 hours in accordance with international guidelines. Ongoing audit of thrombolysis is being carried out.