Included: patients who were eligible for thrombolysis based on the Recommendation 4.6.1B in National Clinical Guidelines for Stroke (see below) are included in this indicator.
Eligible patients:
Patients are included who are either:
- newly arrived patients aged under 80 with a precise or best estimate onset time and an onset to arrival time of less than 3.5h
- newly arrived patients aged 80 or over with a precise or best estimate onset time and an onset to arrival time of less than 2h
- patients already in hospital at time of stroke
except patients with at least one “no but” reason for thrombolysis (Q2.6) that is consistent with information given in other sections.
Information that is not consistent is determined as:
- Precise onset time, and “symptom onset time unknown/wake-up stroke” is the “no but” reason selected.
- Age is under 80 years, and “age” is the “no but” reason selected.
- Onset to arrival time is precise and less than 3.5 hours, age is under 80 years, and time window is the no but reason selected.
- NIHSS at arrival is 4 or more and too mild/severe is the no but reason selected.
- Onset to arrival time is precise and less than 2 hours, age is 80+, and “age” and/or “time window” is the “no but” reason selected.
- Patient is an inpatient in hospital at the time of stroke, and did not have a stroke during sleep, and “time window” is the “no but” reason selected.
|
Excluded: patients who are not eligible based on the Recommendation 4.6.1B in National Clinical Guidelines for Stroke (see below) Excluded patients: Patients are excluded who are either:
|
Numerator = the number of patients who were eligible for thrombolysis (according to the RCP guideline minimum threshold) and given thrombolysis.
Denominator = the total number of patients who were eligible for thrombolysis (according to the RCP guideline minimum threshold), irrespective of whether they received thrombolysis.
To calculate the numerator:
Firstly, identify all patients who were:
- either newly arrived at hospital and
- aged under 80 years, have a precise or best estimate onset time (Q 1.11.2), and the difference between onset time (Q1.11) and arrival time (Q 1.13) is less than 3.5 hours, or
- aged 80 years or over, have a precise or best estimate onset time (Q 1.11.2), and the difference between onset time (Q1.11) and arrival time (Q 1.13) is less than 2 hours
OR
- already in hospital at time of stroke.
Once these patients are identified, count the number of these patients who were given thrombolysis.
Cohort percentage:
| For team-centred | For patient-centred |
| All patients eligible for thrombolysis in the team-centred 72h cohort | All patients eligible for thrombolysis in the patient-centred 72h cohort |
Example
Patient A was 74 years old, their precise symptom onset was at 10:00, they arrived (clock start) at hospital at 12:30 the same day, and were given thrombolysis.
Patient A was eligible as they were under 80 years old, had a precise onset time, and their onset to arrival time (2.5 hours) was less than 3.5 hours. Patient A has achieved the indicator because they were eligible and given thrombolysis.
Patient B was 65 years old, their precise symptom onset was at 13:00, they arrived (clock start) at hospital at 14:30 the same day, and were not given thrombolysis.
Patient B was eligible as they were under 80 years old, had a precise onset time, and their onset to arrival time (1.5 hours) was less than 3.5 hours. Patient B has not achieved the indicator because they were eligible and not given thrombolysis.
Patient C was 90 years old, their best estimate symptom onset was at 20:00, they arrived (clock start) at hospital at 23:00 the same day, and were not given thrombolysis.
Patient C was not eligible as they were over 80 years old and their onset to arrival time (3 hours) was more than 2 hours. Patient C was excluded as they were not eligible.
Patient D was 87 years old, their onset time was not known, they arrived at hospital at 09:00, and were not given thrombolysis. Patient D was not eligible as the onset time was not known.
Patient D was excluded as they were not eligible.
Patient E was 92 years old, their precise symptom onset was in hospital at 14:00 (clock start), and they were not given thrombolysis. The only ‘no but’ reason was age which is an inconsistent reason as there is no age limit on patients with onset in hospital. Patient E was eligible as their onset was in hospital and their ‘no but’ reason was inconsistent.
Patient E has not achieved the indicator because they were eligible and not given thrombolysis.
Patient F was 77 years old, their precise symptom onset was at 13:30, they arrived (clock start) at hospital at 14:30 the same day, and were not given thrombolysis. The ‘no but’ reason was ‘other medical reason’.
Patient F was not eligible as even though they were under 80 years old, had a precise onset time, and their onset to arrival time (1 hour) was less than 3.5 hours the ‘no but’ reason was consistent. Patient F was excluded as they were not eligible.
Patient G was 77 years old, their precise symptom onset was at 13:30, they arrived (clock start) at hospital at 15:15 the same day with a NIHSS at arrival of 4, and were not given thrombolysis. The ‘no but’ reason was ‘stroke too mild or too severe’ which is not a consistent reason as the NIHSS at arrival was greater than 3.
Patient G has not achieved the indicator because they were eligible and not given thrombolysis.
Therefore the cohort percentage is 0.25 or 25% or 1/4 or 