Results of the implementation of the code stroke protocol in a Portuguese hospital

Abstract

Background: The latest therapies for stroke are time-sensitive and require the implementation of care protocols. Objective: To analyze the results of the implementation of a code stroke protocol. Methodology: Quantitative and retrospective analysis of all cases with cerebrovascular disease admitted in the emergency room of a Portuguese hospital, from 2010 to 2016 (n = 1200). Demographic data, times for stroke care, comorbidities, and other clinical variables were collected. All activations of the protocol were studied using electronic records. Results: The patients showed 63.0% ischemic stroke, 17.2% of hemorrhagic stroke, and 19.8% of transient ischemic attacks. The code stroke protocol covered 37.3% (n = 282) of the ischemic stroke cases, performing fibrinolysis in 18.4% (n = 52) of these patients. The mean door-to-needle time was 69.5 minutes. In patients who underwent fibrinolysis, neurological improvements were significant (p < 0.05). Conclusion: There was a high rate of activation of the code stroke protocol, but only 52 patients underwent fibrinolysis. Age, comorbidities, and high rate of rural origin of patients may have influenced the therapeutic window and the inclusion/ exclusion criteria for fibrinolysis.