Introduction: Current AHA/ASA guidelines recommend a door-to-needle time (DTN) of 60 minutes or less when administering tPA for acute ischemic stroke (AIS). Several studies have correlated early administration of tPA for AIS to improved outcomes. At the study setting, emergency medicine pharmacists (EMPs) are part of the acute stroke care team and are heavily involved in initial stroke care including patient evaluation, acute hypertension management, and preparation and administration of tPA. The purpose of this study was to determine the impact of EMPs on the outcomes of patients with AIS treated with tPA in the emergency department.
Methods: This was a retrospective, single-center, cohort study of patients who received tPA between August 1, 2012 and August 30, 2014. Patients were included if they had a preliminary diagnosis of AIS. Patients were excluded if they received tPA at an outside medical facility or received tPA for an indication other than AIS. The primary objective of this study was to compare DTN times with or without EMP involvement in AIS care. Secondary objectives included evaluating changes in neurological status via measurement of the National Institutes of Health stroke scale (NIHSS), rate of symptomatic intracranial hemorrhage, rate of in-hospital mortality, and discharge disposition.
Results: A total of 100 patients were included. EMPs were involved in the care of 49 patients. EMP care was associated with a significant improvement in DTN time (median 46 [IQR 34.5 - 67] minutes vs. 58 [IQR 45 - 79] minutes), p=0.019. There was also a significant improvement in NIHSS scores at 24 hours post-tPA in favor of the EMP group (median NIHSS 1 [IQR 0 - 4] vs. 2 [IQR 1 - 9.25]), p=0.047. There were no other significant differences between groups with regard to secondary outcomes.
Conclusions: The involvement of an EMP in the initial care of AIS patients was associated with a significant improvement in DTN times and NIHSS scores at 24 hours post-tPA.