If the Joint Commission is pushing this out it is impossible to tell, so do it yourself.
http://cjns.metapress.com/content/h50558454080g083/?id=H50558454080G083
Abstract
Background: Stroke thrombolysis is limited by the
"last-seen well" principle, which defines stroke onset time. A
significant minority of stroke patients (~15%) awake with their symptoms
and are by definition ineligible for thrombolysis because they were
"last-seen well" at the time they went to bed implying an interval that
is most often greater than three hours. Methods: A
single-centre prospective, safety study was designed to thrombolyse 20
subjects with stroke-on-awakening. Patients were eligible for inclusion
if they were last seen well less than 12 hours previously, specifically
including those who awoke from sleep with their stroke deficits. They
had a baseline computed tomogram (CT) scan with an ASPECTS score greater
than 5, no evidence of well-evolved infarction and a CT angiogram /
Trans-cranial Doppler ultrasound study demonstrating an intracranial
arterial occlusion. Patients fulfilled all other standard criteria for
stroke thrombolysis. The primary outcome was safety defined by
symptomatic ICH or death. Results: Among 89 screened
patients, 20 were treated with thrombolysis. Two patients (10%) died due
to massive carotid territory stroke and two patients (10%) died of
stroke complications. Two patients (10%) showed asymptomatic
intracerebral hemorrhage (ICH) (petechial hemorrhage) and none
symptomatic ICH. Reasons for exclusion were: (a) ASPECTS ≤ 5 (29); (b)
well-evolved infarcts on CT (19); (c) historical mRS > 2 (17); (d) no
demonstrable arterial occlusion or were too mild to warrant treatment
(10). Conclusions: Patients who awake with their deficits
can be safely treated with thrombolysis based upon a tissue window
defined by NCCT and CTA/TCD.
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