Akutt hjerneinfarkt og trombolyse på Drammen sykehus, en retrospektiv populasjonsstudie.

Abstract

ABSTRACT

BACKGROUND Acute stroke is the third most common cause of death in Norway, and approximately 15 000 patients suffer from stroke each year. Stroke can be of ischemic or hemorrhagic origin. With ischemic stroke, the ultimate goal in treatment is to achieve revascularization in time to prevent irreversible damage to the brain tissue, without increasing the risk of symptomatic intracranial hemorrhage. We studied ischemic stroke and thrombolytic therapy in patients at the Department of Neurology at Drammen Hospital. The aim of the study was to determine the proportion of patients with stroke who received thrombolytic therapy, characteristics of the thrombolytic population, door-to-needle time, and any complications.

METHODS We studied the ischemic stroke population at Drammen Hospital, a total of 419 patients, during 18 months (2011 and first six months of 2012). 31 patients received thrombolytic therapy, and patient information was gathered retrospectively from their records. In cases where validated scale scores (NIHSS, Oxford Handicap Scale and Barthel ADL-index) were missing, we scored patients based on clinical records.

RESULTS Our study revealed that 31 patients (7.4 %) received thrombolytic therapy. Thrombolytic therapy significantly reduced NIHSS (p = 0.000). This was valid for patients both under and over 80 years of age. One patient suffered severe brain edema following treatment, while four patients suffered from minor hemorrhages in the infarction area. Median door-to-needle time for our patients was 75 minutes.

CONCLUSION At 7.4%, Drammen Hospital is behind the goal of treating 20% of ischemic stroke patients with thrombolytic therapy, as proposed by the Norwegian Health Minister. According to our study, patient age did not affect treatment outcome. Door-to-needle time can be improved for instance by improving treatment facilities, e.g. location of CAT-scan. The impact of such a change should be measured in a follow-up study at Drammen Hospital.