Background and Objective:
South Carolina is located in the “buckle” of the stoke belt. Use of the emergency medical services (EMS), intravenous tissue plasminogen activator (IV t-PA) in acute stroke and its correlates, including outcomes have not been trended over time. To study the annual trends in the above acute stroke care parameters we linked the EMS database with the statewide hospital discharge records stored at South Carolina Department of Health and Environmental Control (SC DHEC).
Methods:
The ongoing statewide EMS database linkage with the hospital discharge records stored at SC DHEC, allow us to track EMS and acute stroke thrombolysis in real-time. Patients with a discharge diagnosis of ischemic stroke were included in the analysis. Patients transported via EMS were compared with patients not transported by EMS. Variables considered included patient demographics, stroke center status of the hospital, telemedicine usage and treatment with IV t-PA for the calendar years of 2010-2012.
Results:
In the calendar years of 2010-2012, 10,377; 10,532 and 10,900 hospitalized patients in SC were assigned a primary discharge diagnosis of ischemic stroke respectively. Of these, the number of patients transported by EMS that received IV t-PA (7.1%, 9.5% and 10.2%, in the years 2010-12; χ2 trend =15.3, p < 0.0001) shows a significant increasing linear trend over the number of patients that were not transported by EMS that received IV t-PA (2.5%, 3.6% and 3.7%, in the years 2010-12). Over the three years, patients that are treated with IV t-PA were more likely to be discharged home (39%, 42% and 49% in the years 2010-12 ) and less likely to be discharged to a healthcare institution or expire (61%, 58% and 51% in the years 2010-12; χ2 trend=9.3, p =0.002).
Conclusion:
Transportation by EMS increased the likelihood of receiving IV t-PA. Over three years, IV t-PA usage led to better outcome including increasing discharge to home, decreasing discharge to healthcare institution and death. The real-time data linkage methodology may allow us in future to test the impact of statewide interventions geared to promote the usage of EMS and IV t-PA.
New standardized nursing cooperation workflow to reduce stroke thrombolysis delays in patients with acute ischemic stroke
