Abstract W P214: Identifying Stroke Symptoms in the Field: What are we Missing?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Lindsay Olson-Mack ◽  
Darlene Bourdon ◽  
Barbara Kelley ◽  
Jon Ludwig ◽  
Gilda Tafreshi
Keyword(s):  
Acute Stroke ◽  
Rapid Assessment ◽  
Stroke Care ◽  
Further Education ◽  
Urban Hospital ◽  
Acute Stroke Care ◽  
Exclusion Criteria ◽  
Initial Finding ◽  
Patient Arrival ◽  
Iv Tpa

Introduction: Emergency Departments (ED) are increasingly activating stroke codes based on assessment of stroke symptoms via Emergency Medical Services (EMS). Accurate assessment of stroke symptoms by EMS facilitates rapid assessment in the ED, leading to prompt diagnosis and treatment during an acute stroke. Delays in treatment can occur when stroke symptoms are not recognized in the field. Hypothesis: We hypothesized that trends existed in stroke symptoms most commonly missed by EMS. Methods: A retrospective cohort study of 170 records was reviewed, for all patients receiving acute stroke care at an urban hospital from October 2013 to May 2014. Inclusion criteria: stroke code activation by EMS or in the ED, and patient arrival by EMS. Exclusion criteria: stroke code activations after admission to the hospital, and patients arriving via private transportation. Results: 112 patients met the inclusion and exclusion criteria. 90 patients (80%) had stroke codes were initiated by EMS. The remaining 22 patients had stroke codes initiated by the ED MD after arrival. The records of the 22 patients arriving to the ED without advanced EMS notification were reviewed. Aphasia was documented in the EMS record for 8 patients (36%). An additional 8 patients (36%) with documented stroke symptoms arrived without EMS notification due to improving symptoms or unclear last known well time. Five of the 22 patients (23%) arriving without EMS pre-notification had had aaphasia documented as an initial finding by ED MD, had a stroke code activation and received IV tPA. One of the 5 patients (13%) also had improving symptoms documented by EMS. Conclusion: An opportunity exists for improved recognition of aphasia as a stroke symptom by EMS, including both expressive and receptive components. Likewise, further education is needed correlating aphasia with the likelihood of IV tPA initiation in the ED. This study also highlights the importance of recognizing the waxing and waning nature of stroke symptoms. Rapidly improving symptoms should not preclude stroke code initiation via EMS, as some of these patients are still IV tPA candidates.

Abstract 3379: Benefiting the Community; The Impact of Joining a Regional Stroke Network

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nancy D Papesh ◽  
James Gebel
Keyword(s):  
Acute Stroke ◽  
Care Center ◽  
Tertiary Care ◽  
Cleveland Clinic ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Stroke Treatment ◽  
The Impact ◽  
Iv Tpa

Background: The Cleveland Clinic Health System (CCHS) consists of a large tertiary care center and 10 regional hospitals. It is organized both clinically and administratively into multispecialty organ based Institutes rather than departments. The CCHS re-introduced a regional initiative to standardize stroke care in 2008. Medina Hospital is a 118-bed community hospital in rural North-eastern Ohio, where there is a high stroke burden and previously minimal IV tPA use. Medina Hospital joined the CCHS Stroke Network in November 2009. Hypothesis: We hypothesized that after joining the formally organized stroke CCHS system of care, the proportion of stroke patients receiving IV tPA and the timeliness of administration of acute thrombolytic therapy would both significantly increase. Methods: Data was analyzed from our prospective participation in the Get with the Guidelines-Stroke and the Ohio Coverdell Stroke Registries. Baseline data regarding quality, outcomes and stroke performance measures were reviewed. CCHS initially supported acute stroke care in early 2010 with a telemedicine cart and then introduced 24/7 emergency, on-site, CCHS neurologist, acute stroke call coverage in late 2010. Standardized CCHS stroke care pathways and order sets were also introduced in 2010. The proportion of stroke patients treated with IV tPA in 2010 and 2011 (post- joining CCHS) was compared to 2009 (2-sided Fisher’s exact test), and door-to-needle times were compared from 2010 to 2011 (unpaired t-test). Results: IV tPA treatment utilization increased from 0/69 patients (0%) in 2009 to 9/67 patients (11.8%) in 2010 [exact p=.0033] and 11/46 (19.3%) in the first 7 months of 2011 [exact p=.0001]. Door-to-needle times improved from a mean of 81.4 (95%CI 66.4 to 96.4) minutes in 2010 to 61.7 (95% CI 52.7 to 70.8) minutes in 2011 (p=.0158). Conclusions: Participation in an organized formal collaborative regional hospital stroke treatment network resulted in dramatic improvements from zero IV tPA utilization to greatly exceeding the national benchmark averages for both percentage treatment with IV tPA and door-to-needle time in a rural area where patients previously had minimal access to acute stroke expertise.

Abstract NS8: The Effects of Introducing a Nurse Practitioner Stroke Champion into the Emergency Department

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Lindsay Olson-Mack ◽  
Jacqueline Reardon ◽  
Elton Hedden ◽  
Rowena Carino ◽  
Cynthia VanWyk ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Nurse Practitioner ◽  
Treatment Effectiveness ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Assessment And Treatment ◽  
Iv Tpa

Background and Purpose: Emergency Department (ED) physicians often manage acute stroke patients without Neurology support at the bedside. Without guidance, they are left to rapidly assess, diagnose and treat acute stroke patients with minimal follow up on treatment effectiveness and patient outcomes. We hypothesized that introducing a Nurse Practitioner (NP) as Stroke Champion into an ED that did not have access to in-house Neurology would drive awareness of acute stroke care, and positively change practice to decrease door to needle times. Methods: The NP started in the 24-bed ED in June 2012. The average daily census of the ED for 2012 was 135 patients per day, and from January to June 2012, ED physicians initiated 46 stroke codes. Although Neurologists were available via telephone, ED physicians were left to accurately assess and initiate stroke codes, determine eligibility, and order IV tPA. In collaboration with the Stroke Medical Director, the Stroke NP conducted multiple education sessions regarding timing metrics in acute stroke care and door to tPA goals with ED clinicians, radiology, lab and pharmacy departments. Data was shared with stakeholders monthly to drive performance improvement initiatives. Results: Rapid improvements were made in all metrics. Mean time to CT first image improved by 19.3 minutes (37.3 to 18.0 minutes) in 6 months, and to 14.7 minutes in 1 year. CT result mean turn-around-time decreased by 19 minutes (from 54.0 to 29.1 minutes) in the first 6 months, and by 22.6 minutes (from 54.0 to 26.0 minutes) at 12 months. Likewise, laboratory result turn-around-times dramatically decreased by a mean of 15.9 minutes (54.4 to 38.5 minutes) over 6 months, and by a mean of 23 minutes (54.4 to 31.0 minutes) within 12 months. IV tPA treatment rates increased from 5% to 14.4% of all ischemic strokes. Door to IV tPA treatment times decreased by a mean of 33.9 minutes (104.5 to 70.6 minutes) in 6 months, and by 46.8 minutes (from 104.5 to 57.7 minutes) within the year. Conclusions: Introducing an NP into the ED to serve as Stroke Champion can provide added support to improve care of acute stroke patients by expediting assessment and treatment.

Abstract TP244: A Successful Statewide Initiative to Designate Hospital as Remote Treatment Stroke Centers

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shelley Nichols ◽  
Debbie Camp ◽  
McCord Smith ◽  
Chris Threlkeld ◽  
James Lugtu ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Systems Of Care ◽  
Standard Of Care ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Stroke Registry ◽  
Remote Treatment ◽  
Stroke Systems Of Care ◽  
Stroke Center ◽  
Iv Tpa

Background: As treatment of acute ischemic stroke (AIS) with IV tPA has become standard of care, smaller hospitals with limited resources have struggled to conform to consensus guidelines. To fill this practice gap, stroke systems of care were developed to support smaller, often rural, hospitals in providing standard stroke care to the patients they serve. Methods: As a result of legislative support from the Coverdell-Murphy Act, the Georgia Coverdell Acute Stroke Registry (GCASR) in collaboration with the Georgia Office of EMS (GA OEMS), the Georgia Hospital Association (GHA), and other state partners, developed a method for designating hospitals as Remote Treatment Stroke Centers (RTSC). The primary focus of performance improvement was treatment with IV tPA in eligible patients. Data collection and process change were used to improve the following quality indicators: percentage of eligible AIS patients treated with IV tPA and number of stroke alert notifications. Hospitals were required to partner with an accredited stroke center and use telemedicine to support the decision for administering IV tPA. GA OEMS was charged with reviewing and surveying individual hospitals applying for RTSC status. The GCASR served as the central repository to facilitate data sharing and benchmarking across hospitals. An inter-hospital transfer tool was created for EMS providers, adopted by GA OEMS, and disseminated throughout the state to guide management of patients receiving IV tPA who required transfer from a RTSC to an accredited stroke center. Results: Starting in 2014, pertinent information was distributed and assistance provided to the 24 RTSC eligible GCASR hospitals. At present, 4 hospitals have achieved designation; 1 hospital is pending survey; and several are considering application. In 2012-13 the now 4 RTSC hospitals gave IV tPA to 8 patients. In 2014-15 as these hospitals sought and achieved designation, this number rose to 24. During this same period, stroke alerts increased from 76 to 308. Conclusion: A state-based public health stroke initiative is effective in facilitating the designation of RTSC and thereby improving the delivery of acute stroke care in underserved areas.

Abstract WP273: Evolution of a U.S. County System for Acute Comprehensive Stroke Care

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Radoslav I Raychev ◽  
Dana Stradling ◽  
David M Brown ◽  
Joey R Gee ◽  
David L Lombardi ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Systems Of Care ◽  
Early Recognition ◽  
Stroke Care ◽  
Reperfusion Therapy ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Transfer Rates ◽  
Over Time ◽  
Iv Tpa

Introduction: In an effort to maximize provision of acute stroke therapies, the Emergency Medical Services (EMS) in Orange County, CA (6 th most populous U.S. county) established a system of care whereby patients with suspected acute stroke are taken to hub sites with endovascular treatment (EVT) capability or to spoke hospitals. Patients at spokes with acute ischemic stroke (AIS) and suspected large vessel occlusion (LVO) are transferred by EMS to hubs. Here we examined the relationship between stroke features, hospital transfers, and mortality; and their change over time. Methods: All patients during 2013-2015 were included for whom 911 was called within 7 hours of onset, and EMS personnel declared “acute stroke" at end of initial evaluation. Results: A total of 6,188 patients (mean age 72) had suspected stroke, of which 54.9% were AIS and 19.4% hemorrhagic stroke. Across all patients, transfer rates into hub sites increased over time (OR 1.12 per 3-months, p<0.0001) and differed by diagnosis (p<0.0001), with transfer in 12.0% of hemorrhages (n=122) but only 3.5% of AIS (n=101). Among patients with AIS only, transfer rates into a hub site increased over time (OR 1.08, p<0.0001), spiking mid-2015. Acute reperfusion therapy was given to 28.3% (20.9% IV tPA only, 3.6% IA therapy only, 3.8% IV tPA+IA), but its usage was unrelated to transfer status, and only 11% of all transferred AIS patients received EVT. Across all patients, mortality during acute hospitalization was 8.2% and did not differ by transfer status, but did differ by diagnosis (p<0.0001): 23.6% of hemorrhages vs. 5.4% of AIS. Over time, mortality decreased only among patients with AIS (OR 0.95, p=0.03). Conclusions: There were several favorable features of this acute stroke care system, including that 28.3% of AIS patients received reperfusion therapy and that mortality decreased over time. However, while transfer to EVT-ready sites increased, rates of IA therapy were low. Continued efforts to optimize acute stroke systems of care should be tailored toward increasing EVT by early recognition of LVO and timely triage to hub facilities.

Abstract P37: A Novel Emergency Stroke Alert System Reduces Door-to-CT And Door-to-Needle Time in Patients With Acute Ischemic Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Muhammad A Pervez ◽  
Joshua N Goldstein ◽  
Natalia S Rost ◽  
Joyce Mclntyre ◽  
Joseph Fay ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Stroke Care ◽  
National Guidelines ◽  
Alert System ◽  
Acute Stroke Care ◽  
Post Intervention ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Increased Risk ◽  
Iv Tpa

Background: National guidelines recommend eligible acute stroke patients undergo neuroimaging within 25 min and IV tPA within 60 min. In order to reduce door-to-needle time, we implemented an “ED2CT” virtual group pager which allows ED staff to simultaneously activate the Stroke Team, neuroradiologists, CT technologists, nursing supervisors and pharmacists. Methods: We performed an IRB approved retrospective review of a prospectively acquired cohort of consecutive patients with ischemic stroke presenting to a single tertiary stroke center using our Get With the Guidelines Stroke (GWTG-S) database. We compared patients who received IV tPA within 3 hours of symptom onset pre- (March 2006-April 2008) to post-intervention (September 2008-December 2009) by Wilcoxon or Fisher's exact as appropriate. Results: Overall, there were 56 patients in the pre-intervention and 53 in the post-intervention groups. Patients were 50.5% male, median age was 76 [IQR 63, 85] years, median time to presentation was 50 [IQR 33, 87] min, and median initial NIHSS was 14 [IQR 8, 20]. None of these variables were significantly different between the pre- and post-intervention groups. Implementation of the ED2CT alert was associated with a reduction of 31% in door-to-CT time (29 [22, 40] vs. 20 [16, 29] min; p=<0.001) and 13.5% in door-to needle time (59 [42, 78] vs. 51 [35, 62] min; p=0.02). In addition, there was an increase of 55% in the proportion of patients undergoing CT within 25 min (42.9% vs.66.7 % p=0.01) and 39% in door-to needle within 60 min (51.8% vs. 72.0% p=0.03). Symptomatic intracerebral hemorrhage (sICH) was infrequent among patients receiving IV tPA with or without rescue IA reperfusion (n=109, 8.3%) and those with IV tPA only (n=83, 6.0%); there was a trend in reduced sICH rate post intervention (11.6% vs. 0%; p=0.06). Conclusions: A novel emergency alert system with which the ED attending directly activates multiple members of the acute stroke clinical and imaging team was associated with an improved door-CT time and improved door-tPA time without an increased risk of sICH. This approach aligns acute stroke care activation with trauma and emergency cardiac care and suggests that team-based approaches may be better than specialty -specific responses.

Abstract 99: Geographic Access to Acute Stroke Care in the United States

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Opeolu Adeoye ◽  
Brendan G Carr ◽  
Karen C Albright ◽  
Catherine Wolff ◽  
Michael Mullen ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Response Times ◽  
Demographic Data ◽  
Stroke Care ◽  
The United States ◽  
Fee For Service ◽  
Acute Stroke Care ◽  
Geographic Access ◽  
The Us ◽  
Iv Tpa

Background: Only 5% of ischemic stroke (IS) patients receive IV tPA and less than 1% receive endovascular therapy (ET). Prior work has described access to Primary Stroke Centers (PSC). We describe access of the US population to all facilities that provide IV tPA or ET for IS. Methods: We used US demographic data and IV tPA and ET rates in the 2011 Medicare Provider and Analysis Review (MEDPAR), a claims-based dataset that contains fee-for-service Medicare-eligible inpatient hospital discharges in the US. ICD-9 codes 433.xx, 434.xx and 436 identified IS cases. ICD-9 code 99.10 defined IV tPA treatment. Among IS cases, hospitals that gave any IV tPA were considered IV capable. ET was defined by ICD-9 code 39.74. Hospitals that performed any ET in IS cases were considered endovascular capable. PSCs were defined as hospitals certified as such by the Joint Commission in 2010. We estimated ambulance response times using arc-GIS’s network analyst and helicopter transport times using validated models. Population access to care was determined by summing the population contained within travelsheds that could reach capable hospitals within 60minutes. Results: Of 370351 IS primary diagnosis discharges, 14926 (4%) received IV tPA and 1889 (0.5%) had ET. By ground, 81% percent of the US population had access to IV capable hospitals within 60minutes, 66% had access to PSCs and 56% had access to ET capable hospitals. By air, 97% percent had access to IV capable hospitals within 60minutes, 91% had access to PSCs and 85% had access to ET hospitals. The Figure shows 60 (yellow) and 120 minute (green) access to IV rt-PA capable hospitals. Conclusion: Most of the US population has geographic access to acute stroke care, but treatment rates remain extremely low. Given our definitions of capability, actual access may be less than described. To optimize US stroke care systems and increase the use of acute therapies, pre- and inhospital interventions to overcome barriers in access to acute stroke care are needed.

Abstract W P55: Practice Diversity Among US Neurologists with Respect to the 3 to 4.5-Hour Window for Acute Stroke Thrombolysis

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sunil Mutgi ◽  
Nicholas Lafountain ◽  
Noah Grose ◽  
Michel T Torbey ◽  
Reza Behrouz
Keyword(s):  
Informed Consent ◽  
Acute Stroke ◽  
Online Survey ◽  
Stroke Care ◽  
Scientific Data ◽  
Therapeutic Window ◽  
Exclusion Criteria ◽  
Electronic Survey ◽  
History Of ◽  
Iv Tpa

BACKGROUND: In 2009, the AHA/ASA endorsed extending the Acute Stroke IV tPA treatment window to 4.5 hours. Four additional exclusionary criteria were advised for treating patients in this extended window. It is unknown how the practice of stroke care has evolved since then. We developed an online survey aimed to evaluate the current practice patterns of neurologists when treating patients in the 3 to 4.5 hour therapeutic window. METHODS: We developed a survey utilizing SurveyMonkey.com. The survey included 6 questions, 1. Subspecialty, 2. Frequency of informed consent when giving IV tPA in the 3 to 4.5 hour window, 3-6. Frequency excluding patient's from treatment in the 3 to 4.5 hour window for any of the additional exclusionary criteria. Answer options for questions 2-6 included: always, often (>50% of the time), seldom(<50% of the time), and never. The publicly available AHA/ASA online member directory was utilized to identify physicians meeting criteria: Council: Stroke, Specialty: Neuro/Stroke, Country: USA. The electronic survey was sent by email to 1000 identified physicians. RESULTS: 260 physicians responded, 230 completed the survey in its entirety and were included in our results. Subspecialties were: 83% vascular neurology, 13% general neurology, and 3% other neurology. Informed consent was always obtained by 33%, often by 22%, seldom by 16%, and never by 28%. Responses for specific exclusion criteria for the 3 to 4.5-hour window were as follows: 1) 34% always excluded patients age >80, 23% often, 29% seldom, and 13% never; 2) 31% always excluded patients with concomitant history of diabetes mellitus and stroke, 21% often, 27% seldom, and 22% never; 3) 28% always excluded patients on warfarin with normal INR, 12% often, 15% seldom, and 46% never; 4) 36% always excluded patients with NIHSS >25, 24% often, 28% seldom, and 12% never. CONCLUSION: Among US neurologists who care for stroke patients, there is notable diversity in practice with respect to IV thrombolysis within the 3 to 4.5-hour window. This may depict disparities in individual interpretation and acknowledgement of the scientific data pertaining to the extended window. There is a tendency towards obtaining informed consent and adherence to all four exclusion criteria, but not universally.

Abstract 88: No Disparities in Acute Stroke Treatment in Kaiser Stroke EXPRESS Program

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jeffrey G Klingman ◽  
Meghan Hatfield ◽  
Lauren Klingman ◽  
Benjamin Wilson ◽  
Mai N Nguyen-Huynh ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Acute Stroke ◽  
Healthcare System ◽  
Age Groups ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Acute Stroke Treatment ◽  
Iv Tpa

Background: Prior published studies reported disparities in timely treatment with tPA for stroke patients who were older, African American or female. In 2015, Kaiser Permanente Northern California (KPNC) redesigned its acute stroke care work flow for the entire region, which included immediate evaluation by a stroke neurologist via video, an expedited IV tPA treatment program, rapid CT angiographic investigation, and expedited transfer of appropriate patients with large vessel occlusion (LVO) for endovascular stroke treatment (EST). We sought to evaluate whether disparities exist in acute stroke treatment within the redesigned process. Methods: KPNC is an integrated health care system with 21 certified stroke centers serving 3.9+ millions members. All centers implemented the new program by January 2016. Using clinical data from 1/1/16 to 7/10/16, we evaluated the frequency of IV tPA administration by gender, race, and age groups after implementation of the new process. We performed multivariate analysis with age, gender, race-ethnicity, Kaiser membership, mode of ED arrival (by ambulance vs. private transportation) to assess for any disparities in achieving DTN time. Results: Post implementation, we found no significant differences in the rates of IV t-pa administration in eligible patients based on race, gender, age category (<40 years, 40-64, 65-79, ≥80), Kaiser membership, or mode of ED arrival. In multivariate analysis for factors influencing DTN time, no differences were seen for DTN time <60 minutes. Age (OR=1.02, 95% CI 1.00-1.03, p=0.03) and arrival by ambulance (OR=5.01, 95% CI 3.01-8.60, p<0.001) were associated with a faster DTN time of <30 minutes. Conclusions: Thus far, we have found no disparities in the use of IV tPA or DTN time for a large integrated healthcare system after implementation of the Stroke EXPRESS program. A consistent standardized approach to acute stroke care may help to reduce disparities on the basis of race, gender, age, or even membership in healthcare system.

Abstract 87: Centralization of Acute Stroke Treatment was Associated With a Reduction in Length of Acute Hospital Stay

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sidsel Hastrup ◽  
Soeren Paaske Johnsen ◽  
Paul von Weitzel-Mudersbach ◽  
Claus Ziegler Simonsen ◽  
Niels Hjort ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Stroke ◽  
Clinical Care ◽  
Stroke Care ◽  
Acute Hospital ◽  
Study Cohort ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Stroke Treatment ◽  
Iv Tpa

Introduction: In 2012 a centralization and specialization of stroke services was implemented in Central Region Denmark (CRD) (n= 1.3 million inhabitants). It implied that acute stroke care was to be provided at only 2 units with re-vascularization therapy. Objective: The impacts on length of acute hospital stay (AHS), rate of thrombolysis (IV tPA), evidence-based clinical care and mortality. Methods: Population-based before-and-after registry study. The study cohort included all stroke cases in Denmark, with patients outside CRD being used as comparison to account for general changes in stroke care. The period before (May 2011- April 2012) was compared to after (May 2013 - April 2014) using regression methods, including difference-in-differences (DID) analysis. Potential confounders included age, gender, civil status, previous strokes, diabetes, atrial fibrillation, smoking, alcohol, stroke severity, hypertension and type of stroke. Results: Baseline data in Figure 1. Median length of AHS (days) in CRD decreased from 5 (IQR 7) to 2 (3) vs. from 5 (9) to 5 (8) in the rest of Denmark. IV tPA rates increased from 16% (95CI 14-17) to 19% (17-21) of all acute ischemic strokes in CRD and from 9% (8-10) to 14% (13-15) in the rest of Denmark (DID RR 0.77 (0.66-0.91)). All-or-none rates of 11 process performance measures of in-hospital care increased from 51% (49-53) to 63% (61-65) in CRD vs. 49% (48-50) to 60% (59-61) in the rest of Denmark (DID RR 0.99 (0.93-1.05)). Adjusted 30-days mortality rate decreased non-significantly and comparable to the rest of the country; OR 0.97 (0.71-1.32) vs. OR 0.91 (0.77-1.07) (DID OR 1.03 (0.75-1.41)). Conclusions: Centralization of acute stroke care was associated with a significant reduction in length of AHS when compared to the development in the rest of Denmark. The use of IV tPA and the quality of acute stroke care also improved, but the trend was not different from the rest of Denmark. No changes in the adjusted 30-days mortality were observed.

Sign in / Sign up

Export Citation Format

Share Document