Large numbers of stroke physicians should be used to treat large numbers of stroke patients with IV rt-PA

PurposeOur aim was to investigate the relationship between number of stroke physicians (SPs) and number of patients treated with intravenous thrombolysis (IV rt-PA) per year.MethodsQuestionnaires about the infrastructure of acute stroke care including number of SPs and patients given IV rt-PA from October 2008 to September 2009 were sent to 3877 hospitals in Japan. We compared the number of SPs between: 1) hospitals not giving IV rt-PA for a year vs. hospitals giving IV rt-PA for ≥ 1 patient; 2) ≤ 5 vs. > 5 patients; 3) ≤ 10 vs. > 10 patients; and 4) ≤ 25 vs. > 25 patients. We established cut-off numbers of SPs administering IV rt-PA for ≥ 1, > 5, > 10, and > 25 patients/hospital/year using a sensitivity–specificity curve.ResultsResponses were received from 2488 of the 3877 hospitals (64.2%), and 919 hospitals admitted acute stroke patients. Of these, 385 hospitals were not administering IV rt-PA in that year, 250 hospitals gave IV rt-PA for 1–4 patients, 131 hospitals for 5–9 patients, 102 hospitals for 10–25 patients, and 30 hospitals for > 25 patients. Cut-off numbers of SPs per hospital were 1 doctor administering IV rt-PA for ≥ 1 patient/year (sensitivity, 83.8%; specificity, 84.5%), 2 doctors for > 5 patients (sensitivity, 85.9%; specificity, 74.1%), 3 doctors for > 10 patients (sensitivity, 76.3%; specificity, 75.5%), and 4 doctors for > 25 patients (sensitivity, 86.2%; specificity, 78.5%). An independent factor for IV rt-PA with > 25 patients was ≥ 4 SPs (odds ratio, 3.83; 95% confidence interval, 1.17–12.63; p = 0.027).ConclusionsHigher numbers of SPs should be associated with higher numbers of patients getting IV rt-PA.