Patient Population

Initially, the research included adult patients (>18 years) who presented with sudden-onset stroke symptoms. Additionally, both male and female patients from Pune’s urban population participated in the study.

Sample Groups

Subsequently, researchers organized participants into two distinct groups:

• Code stroke implementation group: 52 patients
• Non-implementation group: 48 patients

Moreover, researchers calculated the sample size using established statistical methods, targeting 80% power at a 5% significance level to detect meaningful differences in NIHSS scores.

Study Timeline

Importantly, the research was divided into two distinct periods:

• Pre-code stroke era: April 2015 to July 2015 (protocol not implemented)
• Code stroke era: August 2015 to April 2017 (protocol active)

Data Collection Methods

Specifically, medical teams recorded comprehensive patient information, including:

• Demographics (age, gender)
• Medical history and risk factors
• Initial stroke severity assessment
• Critical time points: symptom onset, hospital arrival, neuroimaging, treatment administration

• Furthermore, we implemented the ‘SC’ protocol in August 2015. Consequently, the study time period was divided into the ‘pre-SC era’ (April 2015 to July 2015), in which the protocol was not implemented, and the ‘SC era’ (August 2015 to April 2017), in which stroke code was implemented. Regardless of SC activation, patients who arrived at the ED within 4.5 hours of stroke onset were identified. Subsequently, demographic data (age and gender), medical history, and vascular risk factors, including hypertension, diabetes mellitus, atrial fibrillation, ischemic heart disease, valvular heart disease, and smoking, were recorded. Additionally, initial stroke severity was assessed by the NIHSS.
• Next, acute ischemic stroke patients who received IV r-tPA were extracted from the registry and specially encoded in another database. Specifically, the important time points, which include stroke symptoms onset (onset time), presentation to the ED (door time), neuroimaging (CT time), and bolus IV r-tPA administration (needle time), were all specifically recorded by the nursing practitioner. Furthermore, stroke characteristics and outcomes were recorded. Subsequently, follow-up brain imaging by CT or magnetic resonance imaging was routinely performed 24 to 36 hours after IV r-tPA administration to ascertain whether ICH had occurred. Notably, symptomatic ICH was defined as a neurological deterioration (NIHSS > 2 points) occurring within 36 hours and with no radiological findings that might have been responsible for this deterioration other than hemorrhage. Finally, outcomes were assessed by the Modified Rankin Scale (MRS) score at discharge.
• However, a good outcome occurred when the MRS score was <3. In addition, we also analyzed for in-hospital mortality. Specifically, we used an informed consent form, a consent form for IV r-tPA administration, an NIHSS evaluation sheet, a checklist for inclusion and exclusion criteria for IV r-tPA thrombolysis, and a patient information sheet to collect the data

• Data analysis:

  Initially, the data on categorical variables is shown as n (% of cases), and the data on continuous variables is presented as Mean and Standard deviation (SD) if it is normally distributed. Otherwise, the median (min – max) is used across two study groups. Furthermore, the inter-group comparison of categorical variables is done using the Chi-square test / Fisher’s exact probability test.
• Additionally, the statistical significance of inter-group difference of mean of continuous variables is tested using unpaired OR independent sample ‘t’ test for normally distributed variables. Conversely, the Mann-Whitney U test is used for comparing non-normally distributed variables across two study groups. Before analysis, the underlying normality assumption was tested before subjecting the study variables to the t-test. Subsequently, the entire data is entered and cleaned in MS Excel before its statistical analysis.
• Moreover, all the results are shown in tabular as well as graphical format to visualize the statistically significant difference more clearly. Importantly, the p-values less than 0.05 are considered to be statistically significant. Additionally, all the hypotheses are formulated using two-tailed alternatives against each null hypothesis (hypothesis of no difference). Finally, the entire data is statistically analyzed using Statistical Package for Social Sciences (SPSS ver 16.0, Inc., IBM Corporation) for MS Windows.