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Arrival method, slow response often delay
stroke care
DALLAS, August 2008 — Most
stroke patients can’t recall when their
symptoms started or do not arrive at the
hospital in a timely manner, so they cannot
be considered for time-dependent therapies
such as the clot-busting drug tissue
plasminogen activator (tPA), researchers
reported in Stroke: Journal of the American
Heart Association.
“tPA has been demonstrated to
reduce disability from ischemic
(clot-caused), stroke, however, the drug is
only currently approved for use within three
hours of symptom onset,” said Kathryn M.
Rose, Ph.D., lead author of the study and
research associate professor in the
Department of Epidemiology at the University
of North Carolina at Chapel Hill.
“It is important for people
to recognize the symptoms of stroke and
promptly call 9-1-1 (Emergency Medical
Services) when they occur.”
Researchers analyzed data on 15,117 patients
from 46 hospitals enrolled in the North
Carolina Stroke Registry (NCCSR) from
January 2005 to April 2008. The majority
were ages 45 or older; 54 percent were
women; 53 percent of patients arrived by
Emergency Medical Service (EMS); and 38
percent received care at hospitals
designated as stroke centers.
The most common stroke presumptive diagnoses
at admission were:
• blood-clot-related or ischemic stroke — 43
percent,
• transient ischemic attack or TIA — 28
percent,
• bleeding (hemorrhagic stroke) — 9 percent,
and
• unspecified type of stroke — 20 percent.
Only 23 percent of all NCCSR patients
arrived at the hospital within two hours of
symptom onset and were thus suitable for
evaluation to receive tPA.
Current National Institute of
Neurological Disorders and Stroke (NINDS)
guidelines recommend that a patient receive
a computer tomography (CT) scan within 25
minutes of hospital arrival.
In an analysis of 3,549
patients who arrived at the hospital within
two hours of symptoms onset, only 23.6
percent received a CT scan within 25
minutes.
Among this group, researchers
found that those who arrived by ambulance
were more than twice as likely to receive a
timely CT scan than were those who “walked
in” on their own.
Patients receiving care at a Primary Stroke
Center were also more likely to receive a
timely scan than those treated at other
hospitals as were men compared to women.
Neither race, health
insurance status, time of day nor weekday
versus weekend arrival affected how quickly
a CT scan was given.
“Although patients arriving at the hospital
within two hours of symptom onset were
significantly more likely to receive a
timely CT scan than those who did not (24
percent vs. 9 percent), most (76 percent),
did not,” Rose said.
“This points to areas where
stroke systems of care can be improved in
hospitals. Improvements could increase
patients’ access to time-dependent therapies
and potentially reduce disability from
stroke.”
The NCCSR differs from most quality
improvement efforts because it encourages
collection of patient data concurrent with
care as opposed to later collecting it from
medical records.
The NCCSR is one of four
registries originally funded by the Centers
for Disease Control and Prevention as a Paul
Coverdell National Acute Stroke Registry
with a mandate to measure, track and improve
the quality of acute stroke care.
Co-authors are Wayne T. Rosamond, Ph.D.;
Sara Huston, Ph.D.; Carol V. Murphy, R.N.,
M.P.H.; and Charles H. Tegeler, M.D.
Disclosures for individual authors are
available on the manuscript.
The Centers for Disease Control and
Prevention funded the NCCSR via a grant to
the North Carolina Division of Public
Health, which partners with the UNC School
of Public Health.
Editor’s note: Stroke is the
nation’s No. 3 killer and a leading cause of
disability.
The American Academy of
Neurology, the American College of Emergency
Physicians, and the American Heart
Association/American Stroke Association have
created Give Me 5 for Stroke, a campaign
offering the public an easy way to remember
the stroke warning signs by using five short
words: walk, talk, reach, see, feel. It also
encourages emergency department
professionals to quickly recognize,
diagnose, and treat a stroke.
Call 888-4STROKE or visit
www.giveme5forstroke.org.
###
Statements and conclusions of
study authors published in American Heart
Association scientific journals are solely
those of the study authors and do not
necessarily reflect the association’s policy
or position. The association makes no
representation or guarantee as to their
accuracy or reliability.
The association receives
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other companies) also make donations and
fund specific association programs and
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to prevent these relationships from
influencing the science content.
Revenues from pharmaceutical and device corporations are available at
www.americanheart.org/corporatefunding
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