Efficiency of Acute stroke Fast Track Network with an integrated intravenous thrombolytic therapy: Buriram Hospital in Rural of Thailand

Background : Although intravenous (IV) recombinant tissue plasminogen activator (rt-PA) given within ischemic stroke patient is most important treatment. The benefits of an acute stroke referral network for IV thrombolytic therapy in rural area of developing country remain controversial. Objective : We present efficiency of Acute stroke Fast Track Network with an integrated intravenous thrombolytic therapy: Buriram hospital in rural of Thailand, and compare the results with previously published data. Setting : Buriram hospital and hospital in Buriram Acute stroke Fast Track Network. Method : A prospective descriptive study was done in 1280 patients with acute onset symptoms of stroke referred from hospitals in the Buriram Acute stroke Fast Track Network, other hospital in Buriram province or walk-ins. admitted to the medicine division of Buriram hospital between November 2010 and July 2011. The main outcome measure were IV thrombolytic treatment rate, initial National Institutes of Health Stroke Scale (NIHSS) score, door to needle time, onset to treatment time, mean door to CT time, mean door to LAB time, intracerebral hemorrhage and morbidity and mortality at 3 months after onset (mRS). Result : A 939 patients of 1280 were ischemic stroke (73%). A total of 37 patients recruited to Buriram hospital Acute stroke Fast Track Protocol and 20 patient (54%) of those referred from Buriram Acute stroke Fast Track Network. Six patients (16%) among 37 patients from Buriram hospital Acute stroke Fast Track Protocol were received IV thrombolytic therapy. The mean of initial National Institutes of Health Stroke Scale (NIHSS) score before thrombolytic therapy was 14 (range 8-19), mean door to needle time was 73 minutes (range 64-88), mean onset to treatment time was 154 minutes (range 23-225), mean door to CT time was 27 minutes (range 20-34), mean door to LAB time was 28.75 minutes (range 21-45), intracerebral hemorrhage was 1 patient (16%) and morbidity and mortality at 3 months after onset which modified Rankin Scale score [mRS] of 0-6), [mRS 0-1] was 2 patients (33%) , [mRS 2-3] was 2 patients (33%) , [mRS 4-5] was 1 patient (17%), [mRS=6] was 1 patient (17%). These outcomes are less efficiency than in the National institute of Neurological Disorder and stroke and in Thailand studies. Conclusion : Our finding indicated that proper Acute stroke Fast Track Network with an integrated intravenous thrombolytic therapy: Buriram hospital in rural of Thailand where inexperienced center with this therapy is safe and feasible although less efficiency. Empowerment of network and stroke alert promotion in community can reproduce the experience and outcome that should improve the rate of thrombolytic therapy in rural of Thailand. Key words : Acute Stroke Fast Track Network, intravenous thrombolytic therapy.