Introduction: The Australian Stroke Clinical Registry (AuSCR) raw data 2023* suggests that 31.7% of eligible ischaemic stroke patients in Queensland received thrombolysis. The Stroke Foundation acute audit 2023 reflects 10% of eligible ischaemic stroke patients received thrombolysis across Australia. Eligibility is defined as acute ischaemic stroke presentations to hospital within 4.5 hours of symptom onset, not accounting for alternate reasons for appropriately deciding against thrombolysis.
Methods:
Three independent clinical nurse consultants performed a retrospective analysis across 3 sites in Queensland; 2 endovascular centre, and 1 thrombolysis centre to evaluate the reason for omitting thrombolysis in patients deemed eligible based on above criteria. The review occurred for a 3-month time frame, June 2023 to August 2023.
84 patients met the inclusion criteria of stroke presentation within 4.5 hours of symptom onset across our 3 sites
Results:
This retrospective analysis of imaging and case notes, 31 of the 84 patients were deemed to be eligible for thrombolysis. Of those 31 patients, 24 received thrombolysis (77%), 7 patients (23%) were identified as potential missed thrombolysis opportunities.
53 patients deemed ineligible for treatment with thrombolysis based on current consensus guidelines** with varying factors including recent stroke, low National Institute of Health Stroke Scale (NIHSS) ≤ 4, atrial fibrillation on oral anticoagulation, severe disability, and major comorbidities.
Conclusion: This retrospective review across three Queensland stroke centres demonstrates that thrombolysis is considered in most patients presenting with ischemic stroke within 4.5 hours of symptom onset. In contrast to data published by both AuSCR and Stroke Foundation, there are few missed opportunities for thrombolysis based on our review, which considers more factors pertaining to eligibility for thrombolysis than solely timing of symptom onset.
Relevance to clinical practice or patient experience: Appropriate use of thrombolysis in acute stroke is inaccurately reflected by AuSCR data.