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Emergency Medicine International
Volume 2014, Article ID 438737, 6 pages
http://dx.doi.org/10.1155/2014/438737
Research Article

Acute Stroke Care and Thrombolytic Therapy Use in a Tertiary Care Center in Lebanon

1Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
2Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
3Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon

Received 6 June 2014; Accepted 6 July 2014; Published 16 July 2014

Academic Editor: Harold K. Simon

Copyright © 2014 Mazen J. El Sayed et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Thrombolytic therapy (rt-PA) is approved for ischemic stroke presenting within 4.5 hours of symptoms onset. The rate of utilization of rt-PA is not well described in developing countries. Objectives. Our study examined patient characteristics and outcomes in addition to barriers to rt-PA utilization in a tertiary care center in Beirut, Lebanon. Methods. A retrospective chart review of all adult patients admitted to the emergency department during a one-year period (June 1st, 2009, to June 1st, 2010) with a final discharge diagnosis of ischemic stroke was completed. Descriptive analysis was done followed by a comparison of two groups (IV rt-PA and no IV rt-PA). Results. During the study period, 87 patients met the inclusion criteria and thus were included in the study. The mean age was found to be 71.9 years (SD = 11.8). Most patients arrived by private transport (85.1%). Weakness and loss of speech were the most common presenting signs (56.3%). Thirty-three patients (37.9%) presented within 4.5 hours of symptom onset. Nine patients (10.3%, 95% CI (5.5–18.5)) received rt-PA. The two groups (rt-PA versus non rt-PA) had similar outcomes (mortality, symptomatic intracerebral hemorrhage, modified Rankin scale scores, and residual deficit at hospital discharge). Conclusion. In our setting, rt-PA utilization was higher than expected. Delayed presentation was the main barrier to rt-PA administration. Public education regarding stroke is needed to decrease time from symptoms onset to ED presentation and potentially improve outcomes further.