Stroke Centers, tPA

Tipped off by Symtym: A very comprehensive article about the controversy in emergency treatment of CVA's, from Sign On San Diego (a small excerpt of a much larger article):

Some doctors avoid using t-PA because of its potential downside. The drug can cause bleeding in the brain if not given to the right patients.

The American College of Emergency Physicians says t-PA should be considered, but doesn't think its members should be required to make judgments on stroke care without backup from neurologists and neuroradiologists.

Much of the resistance is the concern that hospitals would lose patients if they don't become stroke centers.

"Having brain-attack centers is a big economic issue and a big expense," said Dr. Richard Stennes, who has worked at Paradise Valley Hospital in National City and was former president of the national and state chapters of the American College of Emergency Physicians.

"If paramedics determine this person is a potential stroke patient and take (him or her) to a designated place . . . a whole lot of people will be taken to hospitals where they don't need to go," said Stennes of San Diego. "There's an economic issue here."

He and others estimate that for every patient who did have a stroke, paramedics would divert as many as 10 patients who didn't have a stroke or had one that occurred too long ago for treatment. Migraines, seizures, metabolic problems, drug reactions and hypoglycemia all could resemble symptoms of stroke.