Influence of neurologists’ experience on the outcome of patients treated by intravenous thrombolysis for cerebral ischaemia

Abstract Intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) should be available on a 24/7 basis in hospitals admitting patients with stroke. We aimed at evaluating the influence of the number of patients previously treated with i.v. rt-PA by neurologists on patients’ outcome. For each patient consecutively treated with i.v. rt-PA for cerebral ischaemia at the Lille University Hospital, we determined the number of previous treatments with rt-PA administered by the neurologist. We performed logistic regression analyses to determine the influence of the experience on the outcome evaluated by the modified Rankin scale (mRS) after 3 months, 0–1 meaning independence, and 0–2 meaning absence of handicap. We compared outcomes of patients treated by the 25 % less experienced neurologists with those of trials. Forty-four neurologists treated 800 patients. The experience of the treating neurologist was independently associated with independence (adjusted odds ratio [adjOR] 1.062 for 10 patients more; 95 % confidence interval [CI] 1.008–1.120), and absence of handicap (adjOR 1.076 for 10 patients more; 95 %CI 1.016–1.140) at 3 months, but not with symptomatic intracerebral haemorrhage and death. The proportions of patients from the 1st quartile who were independent and without handicap at 3 months were 37.9 and 51.1 %. Patients treated by less experienced neurologists, have similar outcomes than expected from trials, suggesting t...
Source: Journal of Neurology - Category: Neurology Source Type: research