To the Editor In a study published in JAMA Neurology, Ebinger et al1 assessed the efficacy of prehospital thrombolytic therapy during the golden hour for acute ischemic stroke. The authors concluded that prehospital “thrombolysis entails no risk to the patients’ safety and is associated with better short-term outcomes.” However, limitations in the study’s methods create uncertainty in this assertion. The issue at hand is noted by the authors in the following statement, “Patients with stroke mimics who received [tissue plasminogen activator] were not included in this evaluation of treatment effects.” Thus, the data were not calculated under an intention-to-treat analysis, the current standard for research in a randomized clinical trial.
Fischer K, McDonough V. Stroke Care Within the Golden Hour. JAMA Neurol. 2015;72(4):475-476. doi:10.1001/jamaneurol.2014.4571