Evidence map›Paper›PMID 32231690›Full record

ArticleInterventional neurology2020

Does the Addition of Non-Approved Inclusion and Exclusion Criteria for rtPA Impact Treatment Rates? Findings in Australia, the UK, and the USA.

Louise E Craig, Sandy Middleton, Helen Hamilton, Fern Cudlip, Victoria Swatzell, Andrei V Alexandrov, Elizabeth Lightbody, Dame Caroline Watkins, Sheeba Philip, Dominique A Cadilhac and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Interventional neurology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Heterogeneity in measurement of NIHSS: a systematic review and meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
    Pooled it
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Louise E CraigNursing Research Institute, St Vincent's Health AUS (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia.
Sandy MiddletonNursing Research Institute, St Vincent's Health AUS (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia.
Helen HamiltonNursing Research Institute, St Vincent's Health AUS (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia.
Fern CudlipStroke Team, Good Samaritan Comprehensive Stroke Center, San Jose, California, USA.
Victoria SwatzellMobile Stroke Unit, University of Tennessee Health Science Center at Memphis, Memphis, Tennessee, USA.
Andrei V AlexandrovDepartment of Neurology, University of Tennessee Health Science Center at Memphis, Memphis, Tennessee, USA.
Elizabeth LightbodyCollege of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom.
Dame Caroline WatkinsFaculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom.
Sheeba PhilipEast Lancashire Hospitals NHS Trust, Blackburn, United Kingdom.
Dominique A CadilhacStroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Elizabeth McInnesNursing Research Institute, St Vincent's Health AUS (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia.
Simeon DaleNursing Research Institute, St Vincent's Health AUS (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia.
Anne W AlexandrovMobile Stroke Unit, University of Tennessee Health Science Center at Memphis, Memphis, Tennessee, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundStrict criteria for recombinant tissue plasminogen activator (rtPA) eligibility are stipulated on licences for use in ischaemic stroke; however, practitioners may also add non-standard rtPA criteria. We examined eligibility criteria variation in 3 English-speaking countries including use of non-standard criteria, in relation to rtPA treatment rates.

methodsSurveys were mailed to 566 eligible hospitals in Australia (AUS), the UK, and the USA. Criteria were pre-classified as standard (approved indication and contraindications) or non-standard (approved warning or researcher "decoy"). Percentage for criterion selection was calculated/compared; linear regression was used to assess the association between use of non-standard criteria and rtPA treatment rates, and to identify factors associated with addition of non-standard criteria.

resultsResponse rates were 74% AUS, 65% UK, and 68% USA; mean rtPA treatment rates were 8.7% AUS, 12.7% UK, and 8.7% USA. Median percentage of non-standard inclusions was 33% (all 3 countries) and included National Institutes of Health Stroke Scale (NIHSS) scores > 4, computed tomography (CT) angiography documented occlusion, and favourable CT perfusion. Median percentage of non-standard exclusions was 25% AUS, 28% UK, and 60% USA, and included depressed consciousness, NIHSS > 25, and use of antihypertensive infusions. No AUS or UK sites selected 100% of standard exclusions.

conclusionsNon-standard criteria for rtPA eligibility were evident in all three countries and could, in part, explain comparably low use of rtPA. Differences in the use of standard criteria may signify practitioner intolerance for those derived from original efficacy studies that are no longer relevant.

Indexed as

Eligibility criteriaRecombinant tissue plasminogen activatorSurveyThrombolysis

Identifiers

PMID32231690
PMCPMC7098288

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.