Hospital Treatment of Patients With Ischemic Stroke or Transient Ischemic Attack Using the “Get With The Guidelines” Program

LaBresh, Kenneth A.; Reeves, Mathew J.; Frankel, Michael; Albright, Dawn; Schwamm, Lee H.

doi:10.1001/archinternmed.2007.101

Cited by 177 publications

(170 citation statements)

References 26 publications

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“…Several previous publications have provided detailed descriptions of the GWTGStroke program. 12,13 In brief, GWTG-Stroke is a national stroke quality-improvement program available to any hospital in the United States since the beginning in April 2003. Participating hospitals are instructed to collect deidentified patient-level data on clinical and demographic characteristics, diagnostic testing, treatments, the reason for not treating with tPA, adherence to quality measures, and inhospital outcomes and discharge disposition in consecutive patients hospitalized with stroke.…”

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confidence: 99%

Why are acute ischemic stroke patients not receiving IV tPA?

et al. 2016

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Objective: To determine patient and hospital characteristics associated with not providing IV tissue plasminogen activator (tPA) to eligible patients with acute ischemic stroke (AIS) in clinical practice.Methods: We performed a retrospective cohort study of patients with AIS arriving within 2 hours of onset to hospitals participating in Get With The Guidelines-Stroke without documented contraindications to IV tPA from April 2003 through December 2011, comparing those who received tPA to those who did not. Multivariable generalized estimating equation logistic regression modeling identified factors associated with not receiving tPA.Results: Of 61,698 eligible patients with AIS presenting within 2 hours of onset (median age 73 years, 51% female, 74% non-Hispanic white, median NIH Stroke Scale score 11, interquartile range 6-18), 15,282 (25%) were not treated with tPA within 3 hours. Failure to give tPA decreased over time from 55% in 2003 to 2005 to 18% in 2010 to 2011 (p , 0.0001). After adjustment for all covariates, including stroke severity, factors associated with failure to treat included older age, female sex, nonwhite race, diabetes mellitus, prior stroke, atrial fibrillation, prosthetic heart valve, NIH Stroke Scale score ,5, arrival off-hours and not via emergency medical services, longer onset-to-arrival and door-to-CT times, earlier calendar year, and arrival at rural, nonteaching, non-stroke center hospitals located in the South or Midwest.Conclusions: Overall, about one-quarter of eligible patients with AIS presenting within 2 hours of stroke onset failed to receive tPA treatment. Thrombolysis has improved dramatically over time and is strongly associated with stroke center certification. Additionally, some groups, including older patients, milder strokes, women, and minorities, may be undertreated.

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confidence: 99%

Why are acute ischemic stroke patients not receiving IV tPA?

et al. 2016

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“…The American Heart Association (AHA) and American Stroke Association GWTG‐Stroke database data collection methods have been described previously 7, 8, 9, 10. In brief, participating hospitals used the AHA's Internet‐based Patient Management Tool (Quintiles) to enter data, receive decision support, and obtain feedback via on demand reports of performance on quality measures and recorded data from consecutive admissions for acute ischemic stroke.…”

Section: Methodsmentioning

confidence: 99%

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Myint

Sheng

Xian

et al. 2018

JAHA

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BackgroundThe prognostic value of shock index (SI), heart rate divided by systolic blood pressure, in stroke for clinical outcomes other than mortality is not well understood.Methods and ResultsWe examined the Get With The Guidelines–Stroke (GWTG‐Stroke) data to explore the usefulness of SI in predicting in‐hospital outcomes in 425 808 acute stroke cases (mean age: 71.0±14.5 years; 48.8% male; 89.7% ischemic stroke and 10.3% intracerebral hemorrhage) admitted between October 2012 and March 2015. Compared with patients with SI of 0.5 to 0.7, patients with SI >0.7 (13.6% of the sample) had worse outcomes, with adjusted odds ratios of 2.00 (95% confidence interval [CI], 1.92–2.08) for in‐hospital mortality, 1.46 (95% CI, 1.43–1.49) for longer length of hospital stay >4 days, 1.50 (95% CI, 1.47–1.54) for discharge destination other than home, 1.41 (95% CI, 1.38–1.45) for inability to ambulate independently at discharge, and 1.52 (95% CI, 1.47–1.57) for modified Rankin Scale score of 3 to 6 at discharge. Results were similar when analyses were confined to those with available National Institutes of Health Stroke Scale (NIHSS) or within individual stroke subtypes or when SI was additionally included in the models with or without blood pressure components. Every 0.1 increase in SI >0.5 was associated with significantly worse outcomes in linear spline models. The addition of SI to existing GWTG‐Stroke mortality prediction models without NIHSS demonstrated modest improvement, but little to no improvement was noted in models with NIHSS.Conclusions SI calculated at the point of care may be a useful prognostic indicator to identify those with high risk of poor outcomes in acute stroke, especially in hospitals with limited experience with NIHSS assessment.

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“…Clinical and neurological evaluation scales assist in the standardization of the monitoring process and prognostic estimate of the cases. The treatment of stroke patients accompanied by a neurologist seems to improve the diagnostic and prognostic accuracy for these patients [43][44][45][46][47][48][49][50][51][52][53] . It is fundamental to consider the possibility of differential diagnoses.…”

Section: Stroke In the Emergency Departmentmentioning

confidence: 99%

Guidelines for acute ischemic stroke treatment: part I

Oliveira‐Filho

Martins

Pontes-Neto

et al. 2012

Arq. Neuro-Psiquiatr.

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These guidelines are a result of several meetings from the Brazilian Stroke Society (Sociedade Brasileira de Doenças Cerebrovasculares -SBDCV, website www.sbdcv.org.br), which represents the Scientific Department in cerebrovascular diseases of the Brazilian Academy of Neurology, responsible for technical opinions and educational projects related to cerebrovascular diseases. Members from SBDCV participated in web-based discussion forum with pre-defined themes, followed by a formal onsite meeting in which controversies and final position statements were discussed. Finally, a writing group was created to revise and translate the final document, which was approved by all members of the SBDCV. The final text aims to guide specialists and non-specialists in stroke care in managing patients with acute ischemic stroke. The hemorrhagic stroke guideline has been previously published by the same group 1 . In the final recommendations, Oxford classification for evidence level and recommendation grade was used: EVIDENCE LEVELS1. Randomized controlled clinical trial (RCT) or systematic review (SR) of RCT with clinical endpoints. 2. RCT or SR of lower quality: with substitute, validated endpoints; with subgroup analysis or with a posteriori hypotheses; with clinical endpoints, but with methodological flaws.3. RCT with substitute, non-validated endpoints case-control studies. 4. Study with clinical endpoint, but with a higher potential bias (as in experiment without comparison group and other observational studies). 5. Representative forum or expert opinion without abovementioned evidence. RECOMMENDATION GRADESA Systematic review (homogeneous) of RCT; or single RCT with narrow confidence interval; or therapeutic results of "all or nothing" type. B Systematic review (homogeneous) of cohort studies; or cohort study and RCT of lower quality; or outcomes research or ecological study; or systematic review (homogeneous) of case-control studies; or case-control study. C Case reports (including cohort or case-control study of lower quality). D Expert opinion without critical evaluation, based on physiological or animal studies.In this first part of the guidelines, specific topics included were: epidemiology, stroke as a medical emergency, education, pre-hospital management, emergency management, neuroimaging and laboratory evaluation. A translated version of these guidelines in Portuguese is available in the Society's webpage (www.sbdcv.org.br).

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Hospital Treatment of Patients With Ischemic Stroke or Transient Ischemic Attack Using the “Get With The Guidelines” Program

Abstract: Statistically and clinically significant improvement in 11 of 13 quality improvement measures for the treatment of patients hospitalized for cerebrovascular disease was seen in hospitals participating in the Get With The Guidelines program.

Cited by 177 publications

References 26 publications

Why are acute ischemic stroke patients not receiving IV tPA?

Why are acute ischemic stroke patients not receiving IV tPA?

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Guidelines for acute ischemic stroke treatment: part I

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