Outcomes mostly favorable for ‘too good to treat’ stroke patients

This is my opinion only, but this sounds like an asinine excuse for not giving tPA.
http://www.medwire-news.md/39/96125/Stroke/Outcomes_mostly_favorable_for_%E2%80%98too_good_to_treat%E2%80%99_stroke_patients.html
Most stroke patients considered "too good to treat" with tissue plasminogen activator (tPA) have good outcomes, say researchers.
The exception is patients with previous stroke, who tend to require ongoing rehabilitation or nursing, the team reports in the International Journal of Stroke.
Joshua Willey (Columbia University Medical Center, New York, USA) and co-workers report the outcomes of 127 patients with stroke or transient ischemic attack (TIA) who had "too good to treat" listed as the only reason for not undergoing thrombolysis. These patients accounted for 35.8% of all patients who presented within the thrombolysis treatment window over a 4 year period.
Almost half of the patients had an admission National Institutes of Health Stroke Scale (NIHSS) of 0. The median score was 1 and the range was 0-19. The researchers note that the inclusion of patients with TIA (62%; symptoms resolved spontaneously within 24 hours) may have ensured relatively benign outcomes overall. But they explain: "We included these patients as the stroke neurologist in the emergency room may not know at the time of treatment whether the patient would ultimately improve."
By the time of discharge, 34 patients had an improvement in their NIHSS score, 86 had no change, two had a 1 point increase, and five had larger increases, including one who died of multiple organ failure and sepsis. Overall, 94% of patients had no change or an improvement in their NIHSS score.
Thirteen patients (10.2%) had poor "static outcomes," being discharged to somewhere other than their own home. Nine patients moved to acute rehabilitation, three to subacute rehabilitation, and one died.
But the researchers say that this relatively high rate of poor static outcomes was largely driven by the inclusion of patients with pre-existing neurological deficits caused by prior stroke. On exclusion of these patients, just two (2.1%) had poor static outcomes, with one discharged to an acute rehabilitation facility and one to a nursing home.
"Given how common TGT [too good to treat] is as a reason for not administering [intravenous] tPA, and that outcomes among these patients are still in question, further studies are warranted," say Willey et al.
Until such studies take place, "the decision on whether to thrombolyze TGT patients may rest on a clinical impression of how likely the patient is to be disabled by their mild neurological deficit," they conclude.