CHIH-HAO CHENSUNG-CHUN TANGLI-KAI TSAIMING-JU HSIEHSHIN-JOE YEHHuang K.-Y.JIANN-SHING JENG2021-12-222021-12-22201419326203https://www.scopus.com/inward/record.uri?eid=2-s2.0-84905859344&doi=10.1371%2fjournal.pone.0104862&partnerID=40&md5=2a83585385a8ea242a4fe388d9beeaf8https://scholars.lib.ntu.edu.tw/handle/123456789/590500Background and Purpose: Timely intravenous (IV) thrombolysis for acute ischemic stroke is associated with better clinical outcomes. Acute stroke care implemented with "Stroke Code" (SC) may increase IV tissue plasminogen activator (tPA) administration. The present study aimed to investigate the impact of SC on thrombolysis. Methods: The study period was divided into the "pre-SC era" (January 2006 to July 2010) and "SC era" (August 2010 to July 2013). Demographics, critical times (stroke symptom onset, presentation to the emergency department, neuroimaging, thrombolysis), stroke severity, and clinical outcomes were recorded and compared between the two eras. Results: During the study period, 5957 patients with acute ischemic stroke were admitted; of these, 1301 (21.8%) arrived at the emergency department within 3 h of stroke onset and 307 (5.2%) received IV-tPA. The number and frequency of IV-tPA treatments for patients with an onset-to-door time of <3 h increased from the pre-SC era (n = 91, 13.9%) to the SC era (n = 216, 33.3%) (P<0.001). SC also improved the efficiency of IV-tPA administration; the median door-to-needle time decreased (88 to 51 min, P<0.001) and the percentage of door-to-needle times ?60 min increased (14.3% to 71.3%, P<0.001). The SC era group tended to have more patients with good outcome (modified Rankin Scale ?2) at discharge (49.5 vs. 39.6%, P = 0.11), with no difference in symptomatic hemorrhage events or in-hospital mortality. Conclusion: The SC protocol increases the percentage of acute ischemic stroke patients receiving IV-tPA and decreases door-to-needle time. ? 2014 Chen et al.[SDGs]SDG3tissue plasminogen activator; fibrinolytic agent; tissue plasminogen activator; aged; article; brain hemorrhage; brain ischemia; clinical protocol; controlled study; disease severity; female; fibrinolytic therapy; functional status; heart atrium fibrillation; human; major clinical study; male; mortality; National Institutes of Health Stroke Scale; prognosis; Rankin scale; Stroke Code Protocol; Taiwan; time to treatment; working time; clinical practice; coding; emergency health service; hospital mortality; Stroke; time; treatment outcome; Aged; Clinical Coding; Emergency Service, Hospital; Female; Fibrinolytic Agents; Hospital Mortality; Humans; Male; Practice Patterns, Physicians'; Stroke; Thrombolytic Therapy; Time; Tissue Plasminogen Activator; Treatment Outcomejournal article10.1371/journal.pone.0104862251112002-s2.0-84905859344