Both pre-hospital and in-hospital delays affect stroke care, UNC researchers show
| August 21, 2008 | |
Dr. Kathryn Rose
Stroke patients who can’t recall when their symptoms started or do not arrive at the hospital in a timely manner cannot be considered for medications proven to help reduce the impact of stroke but which must be given within a certain time after the stroke occurs, University of North Carolina at Chapel Hill School of Public Health researchers report in Stroke: Journal of the American Heart Association. Kathryn Rose, PhD, research associate professor of epidemiology, is lead author of the study. Time-dependent therapies such as the clot-busting drug tissue plasminogen activator (tPA) have been proven to reduce disability from ischemic strokes, which are caused by a blood clot). However, the drug is approved for use only within three hours of symptom onset, said Rose. “It is vital for people to recognize the symptoms of stroke and promptly call emergency medical services at 9-1-1 when they occur,” she said. Researchers analyzed data on 15,117 patients from 46 hospitals enrolled in the North Carolina Stroke Registry from January 2005 to April 2008. The majority were aged 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:
Only 23 percent of all registry 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 North Carolina Stroke Registry differs from most quality improvement efforts because it encourages collection of patient data concurrent with care as opposed to collecting it later from medical records. The registry is one of four 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. 
Dr. Wayne Rosamond
Co-authors of the study were Wayne T. Rosamond, PhD, professor of epidemiology; Sara L. Huston, PhD, research assistant professor of epidemiology; Carol V. Murphy, RN, epidemiology instructor, all from the UNC School of Public Health; and Charles H. Tegeler IV, MD, neurology professor, Wake Forest University Baptist Medical Center. The Centers for Disease Control and Prevention funded the registry 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 http://www.giveme5forstroke.org/. Note: Rose can be reached at (919) 966-1967 and kathryn_rose@unc.edu. School of Public Health contact: Ramona DuBose, director of communications, (919) 966-7467 or ramona_dubose@unc.edu. |
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