Hospital Arrival Time and Intravenous t-PA Use in US Academic Medical Centers, 2001–2004

Lichtman, Judith H.; Watanabe, Emi; Allen, Norrina B.; Jones, Steve; Dostal, Jackie; Goldstein, Larry B.

doi:10.1161/strokeaha.109.562660

Cited by 70 publications

(64 citation statements)

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“…8,10,21 Previously published evidence suggests that of all the patients who present to the ED with stroke, the proportion arriving within 3 hours from symptom onset is less than 50% and within 4 hours is approximately 55%. 22 It is possible that the increase in tPA use over time reflects a higher proportion of patients presenting within the appropriate treatment window. We did not have reliable data concerning time from symptom onset to ED presentation to test this hypothesis; however, previous work suggests that the proportion of patients arriving within 2 hours has not changed significantly over time.…”

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confidence: 99%

“…We did not have reliable data concerning time from symptom onset to ED presentation to test this hypothesis; however, previous work suggests that the proportion of patients arriving within 2 hours has not changed significantly over time. 22 This leads us to believe that temporal trends in arrival time may be playing a small role and the more likely explanation is that clinical decision-making and in-hospital systems are leading to more patients receiving tPA. The observed ethnic difference appears to be driven primarily by differences in the recent years of the project when tPA use was increasing dramatically and more so in NHWs.…”

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confidence: 99%

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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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Emerging temporal trends in tissue plasminogen activator use

et al. 2016

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“…2,36 A major factor in this low rate of IV-tPA for AIS is delayed presentation: many patients simply do not reach medical attention or are not assessed within the therapeutic window. 4,7,27 Delayed presentation to medical care is a multifactorial issue. Importantly, many patients do not appreciate the seriousness of their symptoms or fail to recognize that they are having a stroke.…”

Section: Mobile Stroke Treatment Unitsmentioning

confidence: 99%

Application of emerging technologies to improve access to ischemic stroke care

Vuong

Carroll

Tackla

et al. 2017

Neurosurgical Focus

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During the past 20 years, the traditional supportive treatment for stroke has been radically transformed by advances in catheter technologies and a cohort of prominent randomized controlled trials that unequivocally demonstrated significant improvement in stroke outcomes with timely endovascular intervention. However, substantial limitations to treatment remain, among the most important being timely access to care. Nonetheless, stroke care has continued its evolution by incorporating technological advances from various fields that can further reduce patients' morbidity and mortality. In this paper the authors discuss the importance of emerging technologies—mobile stroke treatment units, telemedicine, and robotically assisted angiography—as future tools for expanding access to the diagnosis and treatment of acute ischemic stroke.

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“…14 A study of US academic centers found that although the same percentage of patients presented within 2 hours of stroke symptom onset in 2001 and 2004, the use of IV tPA more than doubled over this time period. 18 Improved system organization at the prehospital and hospital levels as well as greater comfort and experience with use of thrombolytic therapy likely contribute to all of these findings. 11 CSCs did not outperform PSCs with regard to stroke education and antithrombotics by end of hospital day 2, but these results were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Compliance with joint commission measures in state-designated stroke centers

et al. 2013

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BACKGROUND Comparison of state‐designated primary and comprehensive stroke centers (PSCs and CSCs) with regard to adherence to nationally accepted performance standards are scarce. The objective of this study was to examine if a significant association exists between level of designation and fulfillment of Joint Commission (JC) stroke core measures. METHODS A retrospective comparative data analysis of the New Jersey acute stroke registry for the calendar years 2010 and 2011 was performed. JC core measures were compared by hospital level (PSCs vs CSCs). Adjusted odds ratios (aOR) were estimated for association between hospital levels and fulfillment of JC core measures. Median door‐to‐thrombolytic time was also compared. RESULTS There were 36,892 acute stroke admissions. PSCs had 60% of the patients, whereas CSCs had 40%. Hemorrhagic stroke admissions were about 2 times more frequent at CSCs than PSCs (13.3% and 7.1%, respectively). CSCs adhered better to 6 of the 8 JC measures than PSCs. Of eligible patients, 19.5% received thrombolytic therapy at CSCs compared to 9.6% at PSCs, with a 44% difference in provision of thrombolytic therapy (aOR = 0.28, 95% confidence interval: 0.24‐0.34). Median door‐to‐thrombolytic drug times was 65 minutes at CSCs compared to 74.0 minutes at PSCs (P < 0.0001). CONCLUSIONS New Jersey state‐designated CSCs are better at adhering to the JC core stroke measures and have shorter door‐to‐thrombolytic drug times. Journal of Hospital Medicine 2014;9:88–93. © 2013 Society of Hospital Medicine

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Hospital Arrival Time and Intravenous t-PA Use in US Academic Medical Centers, 2001–2004

Abstract: Background and Purpose-Prompt care-seeking behavior is a focus of US national public stroke educational campaigns.We determined whether the time between symptom onset and hospital arrival and the receipt of intravenous tissue-type plasminogen activator (IV

Cited by 70 publications

References 40 publications

Emerging temporal trends in tissue plasminogen activator use

Emerging temporal trends in tissue plasminogen activator use

Application of emerging technologies to improve access to ischemic stroke care

Compliance with joint commission measures in state-designated stroke centers

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