That means the closest ER may be the best one when a stroke strikes but only if the ER team is prepared to give special thrombolytic drugs called tissue plasminogen activators, or tPA, that can break up a clot and cut the risk of brain damage.

The study also shows too many minutes are lost between the time a stroke hits and the time a stroke victim reaches the ER. That delay reduces the number of patients eligible for tPA, which should only be delivered in the first three hours after a stroke occurs. More education of both the public and ER teams could help reduce delays and increase the chance that patients will get tPA.

These findings, from a four-hospital retrospective study of tPA treatment for ischemic stroke led by researchers from the University of Michigan Health System, will be presented May 20 at the annual meeting of the Society for Academic Emergency Medicine in St. Louis, MO.

Despite all the proof that tPA works, emergency physicians have hesitated to use it because of concerns about achieving results similar to centers with specialized stroke teams, and the perceived liability they might face if it causes the patient to hemorrhage, says lead author Phillip Scott, M.D., FAAEM, director of the UMHS Emergency Stroke Team and assistant professor in the U-M Department of Emergency Medicine. But what we have shown is that with diligent use of stroke treatment protocols, and specialty neurologist consultation as needed, the complication rate for patients treated by an ER team is the same as for those treated by specialized stroke teams.

The study looked at data from 140 patients treated with tPA from 1996 to 2001 by emergency physicians at community, university and urban teaching hospitals, and
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
20-May-2002