Hesamedin Askari-Majdabadi1, Zahra Basereh2, Amin Soheili3, Kelly Powers4, Mohsen Soleimani1, Majid Mirmohammdkhani5, Tahoura Afshari Saleh6

1Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
2Department of Emergency Nursing, Semnan University of Medical Sciences, Semnan, Iran
3Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran
4Department of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran
5University of North Carolina at Charlotte, Charlotte, NC, USA
6Department of Emergency Medicine, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran

Keywords: Acute ischemic stroke, emergency department, fibrinolytic therapy, Iran


OBJECTIVES: This study investigated the current status of acute ischemic stroke (AIS) management in an Iranian emergency department (ED).

METHODS: A descriptive study using a retrospective chart review was conducted on medical records of 270 patients with AIS who presented to the ED of a tertiary university hospital in the northeast of Iran from March 22 to September 22, 2019. The steps of this review process included instrument identification, medical records retrieval, data extraction, and data verification.

RESULTS: Of patients with AIS, 88.9% (n = 240) did not receive stroke code activation. For the 11.1% of patients (n = 30) who received activation, 7% of codes (n = 19) were canceled by the acute stroke team and IV recombinant tissue plasminogen activator (r-tPA) was only administered for 4.1% of patients (n = 11). ED arrival outside 4.5 h from symptom onset was the main barrier to IV r-tPA administration for 83.8% of potentially eligible patients with AIS (n = 217). The median door to needle time was 70 min (interquartile range: 47–90 min).

CONCLUSIONS: There was a better clinical performance in terms of critical time goals in potentially eligible patients with AIS if managed with stroke team activation compared to no stroke team activation.

How to cite this article: Askari-Majdabadi H, Basereh Z, Soheili A, Powers K, Soleimani M, Mirmohammdkhani M, et al. Current status of acute ischemic stroke management in Iran: Findings from a single-center study. Turk J Emerg Med 2022;22:213-20.

Ethics Committee Approval

Ethical approval for this study was obtained from the Research Ethics Committee of Semnan University of Medical Sciences. Date of the ethical approval: June 2, 2020. Number of the ethical approval: IR.SEMUMS.REC.1399.074.

Author Contributions

HAM and AS: Conceptualization (lead); methodology (lead); writing – original draft(lead); formal analysis (lead); writing – review and editing(equal). ZB and MS: writing–original draft(lead); writing– review and editing (equal). MM: Software (lead). ZB and KP: Review and editing (equal). ZB and TAS: Investigation; writing – review and editing(supporting). MS: Conceptualization(supporting); writing–original draft(supporting). AS did the overall supervision of the whole study and all authors had made substantial contribution to the study. All authors have read and approved the final manuscript before submission.

Conflict of Interest

None Declared.

Financial Disclosure

This study is funded by the research deputy of Semnan University of Medical Sciences (Project No. A‑10‑78‑8). The funding sources had no role in the study design, in the gathering, analysis, and interpretation of data, in the report’s writing, and in the decision to submit the manuscript for publication. The corresponding author affirms that he had complete access to all the data in the study and had final responsibility for the decision to submit for publication.


The authors would like to thank all those who spent their valuable time participating in this research project, and we are also immensely grateful to the “anonymous” reviewers.