To determine the present status of intravenous recombinant tissue plasminogen activator (IV rt-PA) administration in Japan, we investigated the components of stroke case related to IV rt-PA utilization using a questionnaire sent to hospitals.
Questionnaires about the infrastructure of acute stroke care were sent to 8589 hospitals between August and October 2007. Responses were categorized as follows: 1) stroke service run by stroke physicians (SPs) 24 h/day, 7 days/week (24/7); 2) IV rt-PA utilizable 24/7 (rt-PA hospitals); 3) the total number of SPs. The components related to rt-PA hospitals were analyzed and the significance of the number in SPs to the rt-PA hospital was investigated.
Responses were received from 4690 (54.7%) of 8569 hospitals. Of these, 1466 hospitals were admitting acute stroke patients. 519 of those hospitals were rt-PA hospitals. Of the 1466 (35.4%), 48.4% were serviced 24/7 by SPs, with 75.2% having <5 SPs. Multivariate analysis revealed administration of rt-PA was significantly associated with >4 SPs (odds ratios (OR), 2.8; 95% confidence interval (95%CI), 1.9–4.1; p<0.001). Compared to hospitals with 0–1 SPs as a reference, the OR for rt-PA utilization was 5.6 (95%CI, 2.5–12.9; p<0.001) with 5 SPs, 10.8 (95%CI, 5.0–23.6; p<0.001) with 6–10 SPs, and 37.3 (95%CI, 6.5–213.1; p<0.001) with >10 SPs.
An increased number of SPs was associated with increased IV rt-PA utilization. Development of stroke centers with larger numbers of SPs is therefore urgently needed.
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Published online: February 02, 2009
Accepted: December 15, 2008
Received in revised form: December 11, 2008
Received: September 4, 2008
© 2008 Elsevier B.V. Published by Elsevier Inc. All rights reserved.