Bentley J. Bobrow¹, Bart M. Demaerschalk², Joseph P. Wood¹, Albert Villarin³, Lani Clark⁴ and Anthony Jennings⁵

¹Department of Emergency Medicine Mayo Clinic, Scottsdale, Arizona. ²Department of Neurology ,Mayo Clinic, Scottsdale, Arizona. ³Albert Einstein Medical Center, Philadelphia, Pennsylvania. ⁴Arizona Department of Health Services, Bureau of Emergency Medical Services, Phoenix, Arizona. 5St. Joseph’s Hospital, Lake St. Louis, Missouri.

Abstract

Background:  The 3-hour window for treating stroke with intravenous tissue plasminogen activator (t-PA) requires well-organized, integrated efforts by emergency physicians and stroke neurologists.

Objective: To evaluate attitudes and knowledge of emergency physicians about intravenous t-PA for acute ischemic stroke, particularly in primary stroke centers (PSCs) with stroke neurology teams.

Methods:  A 15-question pilot Internet survey administered by the Arizona College of Emergency Physicians.

Results: Between March and August 2005, 100 emergency physicians responded: 71 in Arizona and 29 in Missouri. Forty-eight percent practiced at PSCs; 48% thought t-PA was effective, 20% did not, and 32% were uncertain. PSC or non-PSC location of practice did not influence endorsement (odds ratio, 0.96; 95% confidence interval, 0.27–1.64). Of those opposing t-PA, 87% cited risk of hemorrhage.

Conclusions:  Most emergency physicians did not endorse t-PA. Improved collaboration between emergency physicians and stroke neurologists is needed.