Virginia Stroke Systems Task Force (VSSTF)
Acute Stroke Transport/Triage t-PA Guidance Statement
Acute stroke is a time critical illness with optimal patient outcomes achieved by rapid assessment, management, and intervention. The sooner an acute stroke is treated, the better the potential outcome. We endorse a pre-and inter-hospital triage plan to promote rapid access for stroke victims to appropriate organized stroke care within three hours of symptom onset. In general this would involve transport to a JC Certified Stroke Center, although consideration may be given to transport to a closer facility, given that facility has a protocol in place for administration of IV t-PA. Determinations of transport priority should be made regionally, with consideration given to availability of appropriate facilities, patient transport times, and patient and/or family choice.
It is important to note that the continuing evolution of scientific evidence indicates successful management of stroke outside the three-hour time window using various modalities. System strategies should be implemented that facilitate expeditious patient evaluation, transport directly to stroke centers, and transfer from non-stroke centers to stroke centers for selected patients with stroke symptoms beyond three hours. The VSSTF endorses currently published national guidelines regarding the treatment of acute stroke patients, including recommendations for the administration of t-PA.
References:
Adams HP, del Zoppo G, Alberts MJ et al. Guidelines for the early Management of Adults with Ischemic Stroke: A Guidline from the American Heart Association / American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovscular Radiology and Intervention Council, and the Athersclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke 2007;38:1655-1711.
Del Zoppo GJ, Saver JL, Jauch EC et al. Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator : A Scientific Advisory From the American Heart Association. Stroke;40:2945-2948.