Intravenous Thrombolysis for Stroke Increases Over Time at Primary Stroke Centers

Prabhakaran, Shyam; McNulty, Maggie; O’Neill, Kathleen; Ouyang, Bo

doi:10.1161/strokeaha.111.640060

Cited by 50 publications

(42 citation statements)

References 13 publications

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“…24 Similar results were shown in a study of Ͼ100,000 stroke patients from an Illinois hospital database; IV-rtPA was administered to more patients with AIS at JC-certified PSCs than at non-JC-certified PSCs (5.7% vs 1.2%; p Ͻ 0.001). 25 The New York State Stroke Center Designation Project demonstrated shorter median times from door to physician contact (10 vs 25 minutes) and CT performance (31 vs 40 minutes) in stroke centers than in nondesignated centers. 26 In the New York Statewide Planning and Research Cooperative System database of 31,000 patients with AIS, thrombolytic therapy was utilized more frequently in stroke centers than in nondesignated centers (4.8% vs 1.7%; p Ͻ 0.001).…”

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confidence: 96%

Overview of key factors in improving access to acute stroke care

et al. 2012

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confidence: 96%

Overview of key factors in improving access to acute stroke care

et al. 2012

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“…Those hospitals achieving PSC certification have been shown to have significant increases in IV thrombolysis rates as well as improved 30-day mortality and readmission outcomes. [27][28][29][30][31][32][33] Thus, the efforts by these 2 hospitals to achieve and maintain PSC status likely contributed to the abrupt rise in tPA use observed in the community. In previous studies, there have been conflicting data concerning sex differences in tPA use.…”

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confidence: 99%

Emerging temporal trends in tissue plasminogen activator use

et al. 2016

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Objective: To explore temporal trends in tissue plasminogen activator (tPA) administration for acute ischemic stroke (AIS) in a biethnic community without an academic medical center and variation in trends by age, sex, ethnicity, and stroke severity.Methods: Cases of AIS were identified from 7 hospitals in the Brain Attack Surveillance in Corpus Christi (BASIC) project, a population-based surveillance study between January 1, 2000, and June 30, 2012. tPA, demographics, and stroke severity as assessed by the NIH Stroke Scale (NIHSS) were ascertained from medical records. Temporal trends were explored using generalized estimating equations, and adjustment made for age, sex, ethnicity, and NIHSS. Interaction terms were included to test for effect modification.Results: There were 5,277 AIS cases identified from 4,589 unique individuals. tPA use was steady at 2% and began increasing in 2006, reaching 11% in subsequent years. Stroke severity modified temporal trends (p 5 0.003) such that cases in the highest severity quartile (NIHSS . 8) had larger increases in tPA use than those in lower severity quartiles. Although ethnicity did not modify the temporal trend, Mexican Americans (MAs) were less likely to receive tPA than nonHispanic whites (NHWs) due to emerging ethnic differences in later years.Conclusions: Dramatic increases in tPA use were apparent in this community without an academic medical center. Primary stroke center certification likely contributed to this rise. Results suggest that increases in tPA use were greater in higher severity patients compared to lower severity patients, and a gap between MAs and NHWs in tPA administration may be emerging. Neurology ® 2016;87:2184-2191 GLOSSARY AIS 5 acute ischemic stroke; BASIC 5 Brain Attack Surveillance in Corpus Christi; ED 5 emergency department; EMS 5 emergency medical services; GAM 5 generalized additive models; GEE 5 generalized estimating equations; ICD-9 5 International Classification of Diseases-9; IQR 5 interquartile range; IRB 5 internal review board; MA 5 Mexican American; NHW 5 non-Hispanic white; NIHSS 5 NIH Stroke Scale; PSC 5 primary stroke centers; RR 5 relative rate; tPA 5 tissue plasminogen activator.Stroke is a leading cause of death and long-term adult disability in the United States. 1,2 Due to reductions in stroke mortality and increased life expectancy, the prevalence of stroke is climbing and predicted to increase by 20.5% by 2030, with the largest increase among Hispanic men (29%). 1 Disparities exist in stroke care in the United States with differences in tissue plasminogen activator (tPA) use based on sex and race-ethnicity demonstrated in academic settings. [3][4][5][6][7] Temporal trends show that tPA use has more than doubled at large, high-volume academic hospitals since the early 2000s, with data suggesting that treatment gaps based on age and race are narrowing. [8][9][10] Yet there is a paucity of information concerning trends in community hospitals, which have been shown to exhibit different trends than academic centers....

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“…Hospitals seeking certification were required to implement elements such as an acute stroke team, written care protocols, coordination with EMS, and creation of a stroke unit 13. Growing evidence indicates that PSCs utilize more rt‐PA than non‐PSCs and have lower mortality rates than noncertified hospitals 16, 17, 18, 19, 20…”

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Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

Aparicio

Carr

Kasner

et al. 2015

JAHA

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BackgroundPrimary stroke centers (PSCs) utilize more recombinant tissue plasminogen activator (rt‐PA) than non‐PSCs. The impact of PSCs on racial disparities in rt‐PA use is unknown.Methods and ResultsWe used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as PSCs by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt‐PA use was defined by the International Classification of Diseases, 9th Revision procedure code 99.10. Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to PSCs. A higher proportion received rt‐PA at PSCs than non‐PSCs in all race/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all P<0.001). In a multivariable model adjusting for year, age, sex, insurance, medical comorbidities, a diagnosis‐related group–based mortality risk indicator, ZIP code median income, and hospital characteristics, blacks were less likely to receive rt‐PA than whites at non‐PSCs (odds ratio=0.58, 95% CI 0.50 to 0.67) and PSCs (odds ratio=0.63, 95% CI 0.54 to 0.74) and Hispanics were less likely than whites to receive rt‐PA at PSCs (odds ratio=0.77, 95% CI: 0.63 to 0.95). In the fully adjusted model, interaction between race and presentation to a PSC for likelihood of receiving rt‐PA did not reach significance (P=0.98).ConclusionsRacial disparities in intravenous rt‐PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non‐PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt‐PA in the fully adjusted model.

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Intravenous Thrombolysis for Stroke Increases Over Time at Primary Stroke Centers

Cited by 50 publications

References 13 publications

Overview of key factors in improving access to acute stroke care

Overview of key factors in improving access to acute stroke care

Emerging temporal trends in tissue plasminogen activator use

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

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