More Than One Quarter of Stroke Patients Reach ED Within Golden Hour

Researchers report that only about one quarter of people who have strokes caused by blocked arteries arrive at a hospital within one hour of the attack—the "golden hour" where treatment with a powerful clot-dissolving drug is expected to work best.

The report also notes that only one in four of patients who do arrive within an hour go on to get tissue plasminogen activator (tPA).

Overall, there is a "modestly improving trend" in time of arrival at hospitals of patients with ischemic stroke, the most common form, says study author Jeffrey L. Saver, MD, director of the Stroke Center at the UCLA.

His team's report uses data from nearly 107,000 stroke patients treated between 2003 and 2007 at 905 hospitals participating in the American Stroke Association's "Get With the GuidelinesStroke" program.

Current guidelines direct that tPA be given for up to 4.5 hours after a stroke occurs, but it is best used during the first three hours. Time of arrival is a key to getting that treatment within that window, the study shows. While one in four patients arriving in the "golden hour" got tPA, only one in eight arriving one to three hours after stroke onset got the drug, and virtually none arriving later than that got the treatment.

The association's public education program stresses the recognition of stroke symptoms, such as a sudden loss of vision, sudden speech problems, sudden severe dizziness, and sudden severe headache.

"We currently tell the public to call 911 when these happen, because 'time is brain' and every delay in getting to the closest stroke center reduces the chance of improvement," Sacco says.

Source: Brigham and Women's Hospital