The Stroke Team is the engine of the UCSD SPOTRIAS Coordinating Center, organized to respond immediately to acute stroke and identify candidates for all of the Center's translational research studies in acute stroke diagnosis and treatment. The Core has 3 specific aims: (1) to respond to code stroke 24 hours per day, 7 days per week;(2) to treat a minimum of 12 patients per year within 2 hours of stroke onset, on the premise that by moving the NINDS guidelines 3-hour time window for thrombolytic treatment up to 2 hours, even better patient response rates than expected from typical rt-PA use can be achieved;and (3) to collect, review, and use quality assurance data (e.g., door-to-physician, door-to-CT scan, door-to-neurologist, and door-to-needle times) to identify and overcome barriers to 60-minute door-to-needle times and thereby improve acute stroke care through expedited delivery. Key features of the Expedited Code Stroke Protocol developed and followed by the Stroke Team include a 2-hour onset-to-treatment benchmark, in-person triage of all Code Stroke calls, unmixed rt-PA at the Emergency Department bedside, proceeding without coagulation test results and chest X-ray unless specifically indicated, no delay for formal CT interpretation, and no delay for written consent. In addition to the study of expanded availability to and expedited evaluation and treatment of acute stroke patients, the Stroke Team collects and coordinates the deposit of blood specimens (Core B) from UCSD Stroke Center clinical sites to the NINDS Coriell DNA Blood Repository and into the SPOTRIAS national repository, a centralized project geared toward eventual exploration of blood markers for stroke, transient ischemic attack, and mimics. In this capacity, the Stroke Team is facilitating and participating in vital research on whether serum biomarkers can be used to triage acutely presenting patients into low-risk and high-risk stratification groups and to predict likelihood of certain outcomes after stroke. As both a Core resource of patient access and a study of expanded and expedited response to acute stroke in the neurocritical context, the Stroke Team is a daily contributor to translational research studies with the common, overarching goal of significantly reducing the staggering economic and social toll of acute stoke in the United States and worldwide through the development and testing of new, improved diagnostic tools and innovative treatments.
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