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Comment & Response |

Treating In-Hospital Stroke—Reply

Alexandra P. Saltman, MD1; Moira K. Kapral, MD, MSc, FRCP(C)1
[+] Author Affiliations
1Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
JAMA Neurol. 2015;72(12):1535-1536. doi:10.1001/jamaneurol.2015.2669.
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In Reply We thank El Husseini and Goldstein for their comments and for highlighting the challenges that exist in distinguishing strokes from conditions that mimic strokes in hospitalized patients.1 The findings from their study lend support for the training of hospital personnel in accurate stroke recognition in conjunction with the development of in-hospital code stroke protocols.

Although many patients with in-hospital stroke may be ineligible for thrombolytic therapy, use of code stroke protocols to streamline stroke identification and management may facilitate access to other aspects of stroke care, including transfer to a designated stroke unit; access to specialized physiotherapy, occupational therapy, and swallowing assessments; timely initiation of medications for secondary stroke prevention; and appropriate discharge planning with referral to inpatient or outpatient stroke rehabilitation. Moreover, the recent demonstration of the superiority of mechanical thrombectomy over systemic thrombolysis alone for patients with large-artery occlusions25 widens the scope for treatment of patients with in-hospital stroke who may have contraindications to systemic thrombolysis, thereby increasing the yield of timely diagnosis in this population.

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December 1, 2015
Nada El Husseini, MD, MHSc; Larry B. Goldstein, MD
1Wake Forest Baptist Medical Center, Winston Salem, North Carolina
2University of Kentucky, Lexington
JAMA Neurol. 2015;72(12):1535. doi:10.1001/jamaneurol.2015.2663.
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