Key result
Primary stroke center practice does not influence emergency physicians' endorsement of t-PA versus non-PSC practice.
Why the study?
The 3-hour window for intravenous t-PA treatment of acute ischemic stroke requires coordinated efforts by emergency physicians and stroke neurologists, but emergency physicians' attitudes and knowledge about t-PA were unclear.
Cross-Sectional (n=100)
Yes
Odds Ratio: 0.96 (95% CI 0.27–1.64)
Less than half of surveyed emergency physicians endorsed the effectiveness of intravenous t-PA for acute ischemic stroke, highlighting a need for improved collaboration with stroke neurologists.
May limit t-PA use in eligible patients; leaves open targeted interventions to improve emergency physician endorsement.
BACKGROUND: The 3-hour window for treating stroke with intravenous tissue plasminogen activator (t-PA) requires well-organized, integrated efforts by emergency physicians and stroke neurologists. OBJECTIVE: To evaluate attitudes and knowledge of emergency physicians about intravenous t-PA for acute ischemic stroke, particularly in primary stroke centers (PSCs) with stroke neurology teams. METHODS: A 15-question pilot Internet survey administered by the Arizona College of Emergency Physicians. RESULTS: Between March and August 2005, 100 emergency physicians responded: 71 in Arizona and 29 in Missouri. Forty-eight percent practiced at PSCs; 48% thought t-PA was effective, 20% did not, and 32% were uncertain. PSC or non-PSC location of practice did not influence endorsement (odds ratio, 0.96; 95% confidence interval, 0.27-1.64). Of those opposing t-PA, 87% cited risk of hemorrhage. CONCLUSIONS: Most emergency physicians did not endorse t-PA. Improved collaboration between emergency physicians and stroke neurologists is needed.
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Bobrow et al. (2009) conducted a cross-sectional in Emergency physicians' views on t-PA for acute ischemic stroke (n=100). Practice at primary stroke centers (PSCs) vs. Non-PSC location of practice was evaluated on Endorsement of t-PA effectiveness (OR 0.96, 95% CI 0.27-1.64). Practice at a primary stroke center did not influence emergency physicians' endorsement of t-PA for acute ischemic stroke compared to non-PSC practice (OR 0.96; 95% CI 0.27-1.64).
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