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Comment & Response
April 2015

Stroke Care Within the Golden Hour

Author Affiliations
  • 1Department of Neurology, University of Campinas, São Paulo, Brazil
  • 2Foisie School of Business, Worcester Polytechnic Institute, Worcester, Massachusetts
  • 3Healthcare Delivery Institute, Worcester Polytechnic Institute, Worcester, Massachusetts
JAMA Neurol. 2015;72(4):475. doi:10.1001/jamaneurol.2014.4568

To the Editor We read with interest the article by Ebinger and colleagues1 in which they demonstrated that the number of stroke patients treated within the golden hour can be increased up to 6 times compared with a hospital-based approach through a mobile unit staffed with a stroke neurologist and technical personnel as well as a computed tomographic scanner and point-of-care laboratory. In an editorial, Warach2 questioned the generality of this pack-and-load approach,1 which was tested in Berlin, Germany, based on financial, logistical, and clinical issues.2 In the United States, less than one-third of patients receive door-to-needle (DTN) treatment within 60 minutes,3 and only 30% of patients arrive within the golden hour. Therefore, it is not surprising that very few people receive thrombolytic therapy in less than the recommended 90-minute onset-to-treatment time,3 and even fewer in less than 60 minutes. The global situation is very different from Berlin’s reality, where 31% of hospital-based patients are treated in fewer than 90 minutes onset to treatment, with a median onset-to-treatment time of 105 minutes.4

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