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Comment & Response |

Stroke Care Within the Golden Hour

Li Min Li, BBA, MD, PhD1,2,3; Sharon Johnson, PhD2,3
[+] 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.
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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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April 1, 2015
Kyle Fischer, MD, MPH; Vince McDonough, MD
1Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore
2Abrazo Health System, Phoenix, Arizona
JAMA Neurol. 2015;72(4):475-476. doi:10.1001/jamaneurol.2014.4571.
April 1, 2015
Martin Ebinger, MD; Heinrich J. Audebert, MD
1Department of Neurology, Center for Stroke Research Berlin, Berlin, Germany
JAMA Neurol. 2015;72(4):476-477. doi:10.1001/jamaneurol.2014.4574.
January 1, 2015
Martin Ebinger, MD; Alexander Kunz, MD; Matthias Wendt, MD; Michal Rozanski, MD; Benjamin Winter, MD; Carolin Waldschmidt, MD; Joachim Weber, MD; Kersten Villringer, MD; Jochen B. Fiebach, MD; Heinrich J. Audebert, MD
1Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany2Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany
1Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
JAMA Neurol. 2015;72(1):25-30. doi:10.1001/jamaneurol.2014.3188.
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