Neurologist rtPA Experience Influences Stroke Outcomes

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Having more experience with intravenous recombinant tissue plasminogen activator (rtPA) can help neurologists improve stroke patients’ outcomes, according to a study published in the Journal of Neurology.

The researchers sought to see how neurologists’ experience with intravenous rtPA influenced stroke patients’ outcomes.

The study included 800 patients consecutively treated with intravenous rtPA for cerebral ischemia at the Lille University Hospital. The researchers then determined how many previous rtPAs each of the 44 treating neurologists had administered and tracked patient outcomes for 3 months.

The researchers performed logistic regression analyses to see if neurologists’ experience affected outcomes, measured by the modified Rankin scale (mRS) at 3 months after treatment. A score of 0-1 represents independence and 0-2 represents absence of handicap.

The results indicated that neurologist experience was independently associated with patient independence and absence of handicap at 3 months. However, it was not associated with symptomatic intracerebral hemorrhage or death.

Patients who were treated by more experienced neurologists only had slightly improved outcomes compared with those treated by those with less experience.

The researchers suggest that the practices of less experienced neurologists be evaluated to ensure patients get the maximum benefit from rtPA. Additionally, hospitals can organize education programs to help all neurologists operate with the same outcomes.

More experienced neurologists can slightly improve stroke outcomes.
More experienced neurologists can slightly improve stroke outcomes.

Intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) should be available on a 24/7 basis in hospitals admitting patients with stroke. We aimed at evaluating the influence of the number of patients previously treated with i.v. rt-PA by neurologists on patients' outcome. For each patient consecutively treated with i.v. rt-PA for cerebral ischaemia at the Lille University Hospital, we determined the number of previous treatments with rt-PA administered by the neurologist. We performed logistic regression analyses to determine the influence of the experience on the outcome evaluated by the modified Rankin scale (mRS) after 3 months, 0–1 meaning independence, and 0–2 meaning absence of handicap.

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