PAW16 Actual workload of acute stroke thrombolysis: how many patients need to be assessed for each one treated?

Introduction Thrombolysis is an established acute stroke treatment. However, many hospitals are still setting up thrombolysis services, often delayed by fears over workload. While many data exist on the proportion of stroke patients receiving thrombolysis, there are few data on how many require urgent assessment before one is thrombolysed. These data are crucial to inform service planning. Methods We prospectively studied all patients referred to the thrombolysis team (neurologists and stroke physicians), February 2009–January 2010, in Southampton General Hospital (catchment population 500 000). The team follows an established 24-h thrombolysis protocol in accordance with European licencing indications. Referring doctors receive regular updates on referral guidelines and arrange cranial imaging for accepted referrals. Results 128 patients were assessed by the thrombolysis team, of which 20 received thrombolysis. The most common reasons for treatment exclusion were: stroke severity (37%), time from onset >3 h (26%) or CT findings (15%). Conclusion Approximately six stroke patients require urgent assessment by the thrombolysis team for every one thrombolysed, despite clear referral guidelines. However, even in our large hospital where 4% of stroke patients are thrombolysed, the overall referral rate, currently, is only 2–3 per week.