Acute Stroke Care in the US

Abstract

Background and Purpose-The Paul Coverdell National Acute Stroke Registry is being developed to improve the quality of acute stroke care. This article describes key features of acute stroke care from 4 prototype registries in Georgia (Ga), Massachusetts (Mass), Michigan (Mich), and Ohio. Methods-Each prototype developed its own sampling scheme to obtain a representative sample of hospitals. Acute stroke admissions were identified using prospective (Mass, Mich) or retrospective (Ga, Ohio) methods. All prototypes used a common set of case definitions and data elements. Weighted site-specific frequencies were generated for each outcome. Results-A total of 6867 admissions from 98 hospitals were included; the majority were ischemic strokes (range, 52% to 70%) with transient ischemic attack and intracerebral hemorrhage comprising the bulk of the remainder. Between 19% and 26% of admissions were younger than age 60 years, and between 52% and 58% were female. Black subjects varied from 7.1% (Mich) to 30.6% (Ga). Between 20% and 25% of admissions arrived at the emergency department within 3 hours of onset. Treatment with recombinant tissue plasminogen activator (rtPA) was administered to between 3.0% (Ga) and 8.5% (Mass) of ischemic stroke admissions. Of 118 subjects treated with intravenous rtPA, Ͻ20% received it within 60 minutes of arrival. Compliance with secondary prevention practices was poorest for smoking cessation counseling and best for antithrombotics. Conclusions

Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke

“…A total of 1 348 585 patients from 1582 hospitals were included in this initial sample. Major exclusion criteria were applied as follows: (1) sites with <30 patients (140 sites; 1773 patients) and (2) in-patient strokes (16 897). We further restricted the study population to patients with ischemic stroke who did not receive experimental therapies and who were not transferred out from the GWTG registry hospital to another acute care facility.…”

“…Даже с учетом того, что этот метод являет-ся единственным одобренным методом лечения инсуль-та, частота проведения системного тромболизиса среди всех пациентов с ИИ остается чрезвычайно низкой [2]. Во многих небольших клиниках нет возможности про-водить обследование и мониторинг состояния пациентов с инсультом [3].…”

“…1 Even though it is the only approved therapy for stroke, rates of tPA administration to all patients with ischemic stroke are exceedingly low. 2 In many small-to medium-sized hospitals, the infrastructure required for the ongoing evaluation and monitoring of patients with post-tPA stroke may not be available. 3 In addition, the absence of neurointensive or neurosurgical resources to manage post-tPA complications, such as symptomatic intracranial hemorrhage (sICH), may result in lower rates of tPA use.…”

Skubios medicinos pagalbos paieškos delsimas susirgus ūminiu miokardo infarktu

“…[13] tiriamųjų, Amerikoje mažiau nei 10 proc. pacientų į ligoninę atvyko per pirmą valandą nuo simptomų pradžios [15]. Delsimo laiko mediana (25; 75 procentilės) taip pat pasiskirsto nevienodai: mūsų atliktame tyrime 235 (89; 728) min., Graikijoje 210 (120; 480) min.…”

The Need for New Therapies for Acute Ischaemic Stroke

“…The odds ratio of a favourable outcome at 3 months was found to decrease as the OTT increased, with greatest benefit being observed following initiation of treatment within 90 min of stroke onset (table 1a). In clinical practice, however, rt-PA is most often administered between 120 and 180 min, where the benefit of rt-PA use is smaller [13]. …”