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RMJ. 2009; 34(1): 43-46


Time to Hospital Evaluation in Patients of Acute Stroke for Alteplase Therapy

Asad Mahmood,* Muhammad Ashraf Sharif,** Umar Zafar Ali,* Muhammad Naeem Khan*.

Abstract
Objective: To determine the time from onset of symptoms to hospital evaluation in
patients with acute cerebro-vascular accidents to assess their eligibility for thrombolytic
therapy.
Materials and Methods: This cross sectional observational study was carried out from
March 2004 to September 2004 at the Department of Neurology, Military Hospital,
Rawalpindi on 95 patients with acute cerebro-vascular accident. Patients of stroke
presenting in outpatient and emergency department within 72 hours of onset of symptoms
were included in the study. NIH Stroke Scale (NIHSS) was assessed at time of admission
and all had CT scan. Time of onset of symptoms, arrival at ER/OPD to time taken by
resident or neurologist in attending patient and time of getting CT scan were noted.
Results: Of 95 patients, 20 (21%) were hemorrhagic and 75 (79%) were ischemic in
nature. Median time of arrival to hospital from onset of symptoms was 12hrs (range 1-
72hrs). Median time taken by resident to attend patient was 10min (range 2- 30mins). CT
brain was performed within 90min (range 10-390) after arrival in hospital. Arrival within
2
2
3 hours of symptoms was seen in 16 (16.8%) patients, 13 (13.7%) patients within 6hrs
while 66 (69.5%) patients after 6hrs. When adjusted for hospital delay and excluding the
patients with hemorrhagic infarcts, 4 (4.2%) patients arrived within 3hrs and were most
appropriate candidates for thrombolytic therapy. There were 11 (11.6%) patients assessed
within 6hrs while the majority 80 (84.2%) came after 6hrs.
Conclusion: Most patients with stroke do not reach hospital in time and are not suitable
candidates for thrombolytic therapy. (Rawal Med J 2009;34:43-46)

Key words: Stroke, cerebrovascular accident, thrombolytic therapy.



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