• Julien Joux, Stéphane Olindo, Annette Girard-Claudon, Nicolas Chausson, Martine Saint-Vil, Aissatou Signate, Mireille Edimonana, Severine Jeannin, Mathieu Aveillan, Philippe Cabre, and Didier Smadja.
• Neurology and Stroke Center, University Hospital of Fort-de-France, Martinique. julien_joux@hotmail.com
• Clin Neurol Neurosurg. 2013 Sep 1;115(9):1583-5.

ObjectivesNarrow therapeutic window is a major cause of thrombolysis exclusion in acute ischemic stroke. Whether prehospital medicalization increases t-PA treatment rate is investigated in the present study.Patients And MethodsIntrahospital processing times and t-PA treatment were analyzed in stroke patients calling within 6h and admitted in our stoke unit. Patients transferred by our mobile medical team (SAMU) and by Fire Department (FD) paramedics were compared.Results193 (61.6%) SAMU patients and 120 (38.4%) FD patients were included within 30 months. Clinical characteristics and onset-to-call intervals were similar in the two groups. Mean door-to-imaging delay was deeply reduced in the SAMU group (52 vs. 159 min, p<0.0001) and was <25 min in 50% of SAMU patients and 14% of FD patients (p<0.0001). SAMU management was the only independent factor of early imaging (p=0.0006). t-PA administration rate was higher in SAMU group than in FD group (42% vs. 28%, p=0.04). Proportion of patients with delayed therapeutic window was higher in FD group than in SAMU group (38% vs. 26%, p<0.0001).ConclusionPrehospital transfer medicalization promotes emergency room bypass, direct radiology room admission and high thrombolysis rate in acute ischemic stroke.Copyright © 2013 Elsevier B.V. All rights reserved.

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