Abstract TP357: Top Reasons Why IV r-TPA Not Given in Wisconsin Rural and Primary Stroke Center Hospitals

Background and Issues— Stroke continues to be a significant cause of morbidity and mortality. Research has shown improved outcomes when IV tPA is started as close as possible to the time the patient was last known well. Although the use of IV tPA has increased over time, there still an opportunity to increase the use of IV tPA so more patients may benefit from this acute intervention. Purpose— To explore the top reasons documented for not giving IV tPA in WI Rural and WI PSC Hospitals. Methods— Two groups (Rural and WI PSC) were established in Wisconsin through the Get With The Guidelines-Stroke database. The Rural hospital group includes an average of 13 hospitals with 282 total documented reasons for no IV tPA being given. The WI PSC Hospital group includes 26 hospitals with 2552 documented reasons for not giving IV tPA. The time period in which these reasons were tracked was January 1, 2008 through December 31, 2011. Reasons were ranked as a percentage of the whole for each group, and the top five are listed in the Results section. Results— Conclusions— Advanced age and rapid improvement of symptoms are commonly documented reasons for not giving IV tPA in both Rural and PSC Hospitals in WI. Rural hospitals also note some facility reasons; whereas the PSC hospitals noted delay in presentation to their facility or that tPA was started elsewhere as common reasons for not administering this acute intervention. Of all the reasons listed above, the patient that already received tPA at another institution is the only absolute contraindication for more tPA. An opportunity exists to increase education to providers on weighing the relative risk for tPA criteria versus the potential benefit of the patient, as well as community education of early treatment necessity. Further research is also needed to determine other factors (i.e. salvageable penumbra) in deciding on treatment options.