Analysis of a coordinated stroke center and regional stroke network on access to acute therapy and clinical outcomes

Marilyn M. Rymer, Edward P Armstrong, Gary Walker, Sissi Pham, Denise Kruzikas

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background and Purpose-: Compare access and outcomes in a tertiary care community hospital (Saint Luke's Neuroscience Institute) and its stroke network to hospitals in 3 national databases. Methods-: Retrospective analysis of ischemic stroke patients (2005, 2007, 2010) in Saint Luke's (n=1576), Get With The Guidelines-Stroke (n=423 809), Premier (n=91 598), and Merci Registry (n=966). Study measures were use of computed tomography scans and tissue plasminogen activator (tPA), symptomatic intracranial hemorrhage, discharge disposition, discharge National Institutes of Health Stroke Scale scores, and 90-day modified Rankin Scores. Results-: Saint Luke's increased access to care with higher tPA use than other hospitals (17.2% received intravenous tPA therapy compared with 5.8% at Get With The Guidelines-Stroke hospitals, P<0.001; 22.1% of Saint Luke's patients received tPA by any route compared with 3.5% of Premier patients, P<0.001). Use of intravenous tPA within 4.5 hours of onset was associated with more discharges to home (odds ratio, 2.123; 95% confidence interval, 1.394-3.246) and improved National Institutes of Health Stroke Scale scores (P=0.001). Saint Luke's patients also were more likely than those in other hospitals to receive computed tomography scans (99.4% vs 58.6% at Premier hospitals). Embolectomy at Saint Luke's was associated with better outcomes than peer hospitals, and treatment at Saint Luke's was independently associated with more discharges to home (odds ratio, 3.92; 95% confidence interval, 1.84-8.32). In 2010, symptomatic intracranial hemorrhages after tPA therapy was similar for Saint Luke's patients and Premier patients (2.2% vs 1.5%; P=0.590). Conclusions-: Regionally coordinated stroke programs can substantially improve access and patient outcomes.

Original languageEnglish (US)
Pages (from-to)132-137
Number of pages6
JournalStroke
Volume44
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Tissue Plasminogen Activator
Stroke
Intracranial Hemorrhages
National Institutes of Health (U.S.)
Therapeutics
Odds Ratio
Tomography
Guidelines
Confidence Intervals
Embolectomy
Community Hospital
Tertiary Healthcare
Neurosciences
Registries
Databases

Keywords

  • guidelines
  • stroke
  • thrombolytic
  • tissue plasminogen activator

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Analysis of a coordinated stroke center and regional stroke network on access to acute therapy and clinical outcomes. / Rymer, Marilyn M.; Armstrong, Edward P; Walker, Gary; Pham, Sissi; Kruzikas, Denise.

In: Stroke, Vol. 44, No. 1, 01.2013, p. 132-137.

Research output: Contribution to journalArticle

Rymer, Marilyn M. ; Armstrong, Edward P ; Walker, Gary ; Pham, Sissi ; Kruzikas, Denise. / Analysis of a coordinated stroke center and regional stroke network on access to acute therapy and clinical outcomes. In: Stroke. 2013 ; Vol. 44, No. 1. pp. 132-137.
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