Perspective: The Role of tPA in Stroke – ACEP’s Clinical Policy Fuels Ongoing Debate
By Charles A. Pilcher MD FACEP
September, 2013
How valuable is tPA in stroke? While tPA has become the standard of care for patients who qualify, the numbers are less than impressive and the benefit marginal. Studies generally show that patients treated with tPA seem to have a better outcome compared to “no treatment” in from 5% to at most 15% of cases. ACEP recently published a policy on the matter, which is surprisingly ambivalent. For example, tPA should be “offered” and “considered” rather than the more powerful word “administered.” This forces both patients, physicians, and attorneys, both defense and plaintiff, to view the issue cautiously. More ->
In other news:
Physician overconfidence leads to error
How is a doctor to be taught from their mistakes? Quote: “The whole medical enterprise is based on the fact that one goes to a doctor in the belief that doctors usually know what they’re doing, otherwise you won’t go. If a doctor said, ‘you know, I’m kind of wrong half the time,’ no one is going to come to them.” There are some fascinating primary and secondary links in the article.
Bell’s Palsy or Stroke: Emergency physicians CAN tell the difference
Enough said. To read the article by Dr. Jahan Fahimi in Annals of Emergency Medicine, click here. Tests aren’t generally needed.
Do ER docs and consultants agree?
Yes, most of the time, according to Iwata et al in the July 8 issue of the International Journal of Emergency Medicine. They further discuss issues of management when differences of opinion do arise.
15 things to know about HIPAA changes
If you have questions about the September changes in the HIPAA rules, here’s where to get answers.