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Stroke treated significantly faster and just as safely by medical residents
Date:2/24/2009

St. Louis, February 24, 2009 Diagnosing acute stroke is a high-pressure decision. The speed with which treatment is delivered makes all the difference. Early treatment can stop brain damage, but if treatment is given inappropriately, it can dangerously increase the risk of bleeding in the brain.

Because of this risk, the final decision to administer stroke treatmenta clot-busting enzyme known as tissue plasminogen activator (tPA)is usually reserved for neurologists or, in some cases, other attending physicians. But now a study conducted by researchers at Washington University School of Medicine in St. Louis with neurology residents at Barnes-Jewish Hospital has shown that residents with appropriate training can safely make the call, ensuring that effective treatment is delivered faster.

"Door-to-needle" times, measured as the time between a patient's arrival and the administration of tPA, were reduced by 26%, from an average of 81 minutes to 60 minutes.

"What's critical here is ability to safely reduce 'door-to-needle' time without unnecessarily increasing the risk of a brain hemorrhage," says Jin-Moo Lee, M.D., Ph.D., director of the cerebrovascular section in Neurology at Washington University and Barnes-Jewish Hospital. "What we've shown is that with proper training, feedback and supervision, residents are more than capable of making this complex decision safely."

The study appears online in Stroke.

Although they have completed medical school and passed the license exams necessary to practice general medicine, residents are working in hospitals to undertake more advanced postgraduate training. A select group of critical life-and-death treatment decisions traditionally have been reserved only for physicians who have already completed their residencies.

Stroke treatment is one such decision. At academic and community medical centers, it is usually held for specialists in neurology, or, in some cas
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Contact: Michael C. Purdy
purdym@wustl.edu
314-286-0122
Washington University School of Medicine
Source:Eurekalert

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