There have been tremendous strides in standardization of the care for acute ischemic stroke since widespread use of thrombolytic therapy began almost 20 years ago. Efficacy is still limited by delayed presentation to the emergency department following stroke symptom onset, although this has also improved in that period with education of emergency medical services and the community at large. The real improvement lies in development of streamlined and standardized protocols for “code stroke,” so that thrombolysis rates of 20% are becoming typical and door-to-needle times are just as typically under 1 hour. These encouraging developments are enhanced yet further by the evolution of stroke units, multidisciplinary stroke teams, and telemedicine to maximize the benefit of whatever window of opportunity presents to the emergency department door. Of course, these developments have primarily been aimed through these years at that door.
Dulli DA. In-Hospital StrokeHidden in Plain Sight. JAMA Neurol. 2015;72(7):746. doi:10.1001/jamaneurol.2015.0370