Age and Ageing 2004; 33: 116-121
© 2004, British Geriatrics Society
Systematic Review |
A systematic review of barriers to delivery of thrombolysis for acute stroke
1 University Department of Geriatric Medicine, Level E (MP807), Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
2 Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia
3 ,*Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
Address correspondence to: J. Kwan. Fax: (+44) 2380 796128. Email: jk{at}1to1.org
Abstract
Background and purpose: barriers within the patient pathway can prevent early administration of thrombolytic therapy in patients admitted with acute stroke. This systematic review aimed to identify such barriers that have been reported in the medical literature.
Methods: we searched MEDLINE and EMBASE for prospective and retrospective observational studies that assessed the nature of barriers to delivery of thrombolysis for acute stroke.
Results: we identified 54 eligible studies (including a total of 39,030 patients). The reported barriers included: (i) the patient or family did not recognise symptoms of stroke or seek urgent help, (ii) the general practitioner (rather than an ambulance) was called first, (iii) the paramedics and emergency department staff triaged stroke as non-urgent, (iv) delays in neuroimaging, (v) inefficient process of in-hospital emergency stroke care, (vi) difficulties in obtaining consent for thrombolysis, and (vii) physicians’ uncertainty about administering thrombolysis.
Conclusions: we identified important pre-hospital and in-hospital barriers that should be overcome if thrombolysis is to be administered to stroke patients efficiently and equitably.
Keywords: stroke, hospitalisation, medical systems, hospital, thrombolytic therapy, CVA
Received February 12, 2003; accepted in revised form September 18, 2003.
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