Eligibility of stroke units in Poland for administration of intravenous thrombolysis A. Czlonkowska a,b , I. Sarzyn ´ ska-Dlugosz a , M. Niewada a,b and A. Kobayashi a,b a 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw; b Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland Keywords: acute stroke, classification, stroke unit, thrombolysis Received 25 November 2004 Accepted 15 February 2005 Systemic thrombolysis treatment was approved in Poland in 2003 and should be performed in specialist stroke units (SU). We performed a survey to determine stroke service preparedness for thrombolysis treatment in Poland. We sent a questionnaire evaluating the neurological departments in Poland, where stroke patients are treated. We divided them into four categories: (i) class A SU (fulfilling criteria of the National Program for Stroke Prevention and Therapy and European Stroke Initiative guide- lines), (ii) class B (conditionally fulfilling criteria), (iii) class C (not fulfilling criteria), and (iv) departments without SU. Only class A units are eligible for implementing thrombolysis. We obtained response from 194 of 222 (87.4%) departments; 90 (46.4%) declared having an SU. According to criteria, 20 class A, 56 class B, 14 class C. During one year, 71 208 patients were admitted to hospitals; 69 982 (98.2%) to neurological departments. A total of 10 959 (15.4%) were treated in class A SU, 23 650 (33.2%) in class B, 5153 (7.2%) in class C, whereas 30 220 (42.4%) in neu- rological departments without SU. Our survey showed that only 15.4% stroke patients in Poland are admitted to high-quality SU, where thrombolysis may potentially be administered. Improvement of SU quality in Poland is necessary for wide imple- mentation of new methods of stroke therapy. Introduction The World Health Organisation (WHO) Region Eur- ope recommended in the Helsingborg Declaration that all acute stroke patients should have access to specialist stroke care [1]. The Executive Committee of the Euro- pean Stroke Initiative (EUSI) also recommend systemic thrombolysis treatment should be undertaken in a stroke unit (SU), because all stroke patients benefit from treatment and rehabilitation in such a setting: males and females, young and elderly, and patients with mild, moderate and severe stroke [2,3]. The systematic review, which contains information on almost 5000 patients from 23 clinical trials, confirms that stroke patients who were managed in an SU were less likely to die, require institutional care or have long-term dependency [4]. SU might work very well, because they facilitate systemic diagnostic evaluation and observa- tion in the acute stage, as well as acute medical treat- ment including thrombolysis and early mobilization/ rehabilitation [5]. A group of experts of the Polish National Program for Stroke Prevention and Therapy has published many guidelines on stroke treatment, rehabilitation, stroke unit organization and secondary prevention in stroke [6–8]. According to these guidelines, all stroke patients in Poland should be treated in an SU [8]. SU are being organized in Poland since 1997. An analysis of stroke morbidity [9,10] revealed that there should be 120 spe- cialized stroke-care units in Poland. Thrombolysis treatment with recombinant tissue plasminogen activator (rt-PA) given within 3h of stroke onset to patients with acute ischaemic stroke was proven as safe and effective in the National Institutes of Neurological Disorders and Stroke (NINDS) study [11]. The American Heart Association, The American Academy of Neurology and The National Stroke Association approved the treatment schedule [12–14]. If the NINDS protocol is followed strictly, then outcome results are similar to the original study (conducted in Academic Medical Centers) and can be obtained in community hospitals also [15], provided that it is per- formed in a setting of a specialist stroke service. In the year 2002, rt-PA was conditionally approved by the European Agency for the Evaluation of Medi- cinal Products (EMEA) for treatment of acute ischae- mic stroke. The approval will lapse in 2005 and will then be revised [16]. The conditions for temporary registration are: conduction of a large safety monitoring study – The Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST) and a rand- omized, placebo-controlled, double-blind trial with Correspondence: Iwona Sarzyn´ska-Dlugosz, 2nd Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9 Str., 02-957 Warsaw, Poland (tel.: +4822 4582831; fax: +4822 8424023; e-mail: iwona.dlugosz@mp.pl). 220 Ó 2006 EFNS European Journal of Neurology 2006, 13: 220–224