Format

Send to

Choose Destination
See comment in PubMed Commons below
Stroke. 2012 Apr;43(4):1089-93. doi: 10.1161/STROKEAHA.111.635334. Epub 2012 Jan 26.

Organization of a United States county system for comprehensive acute stroke care.

Author information

1
University of California Irvine Medical Center, 101 The City Drive South, Building 53 Room 203, Orange, CA 92868, USA. scramer@uci.edu

Abstract

BACKGROUND AND PURPOSE:

Organized systems of care have the potential to improve acute stroke care delivery. The current report describes the experience of implementing a county-wide system of spoke-and-hub stroke neurology receiving centers (SNRC) that incorporated several comprehensive stroke center recommendations.

METHODS:

Observational study of patients with suspected stroke of <5 hours duration transported by emergency medical system personnel to an SNRC during the first year of this system.

RESULTS:

A total of 1360 patients with suspected stroke were evaluated at 9 hub SNRC, of which 553 (40.7%) had a discharge diagnosis of ischemic stroke. Of these 553, intravenous tissue-type plasminogen activator was administered to 110 patients (19.9% of ischemic strokes). Care at the 6 neurointerventional-ready SNRC was a major focus in which 25.1% (99/395) of the patients with ischemic stroke received acute intravenous or intra-arterial reperfusion therapy, and in which provision of such therapies was less common with milder stroke, older age, and Hispanic origin. The door-to-needle time for intravenous tissue-type plasminogen activator met the <60-minute target in only 25% of patients and was 37% longer (P=0.0001) when SNRC were neurointerventional-ready.

CONCLUSIONS:

A stroke system that incorporates features of comprehensive stroke centers can be effectively implemented with substantial rates of acute reperfusion therapy administration. Experiences potentially useful to broader implementation of comprehensive stroke centers are considered.

PMID:
22282882
PMCID:
PMC3314728
DOI:
10.1161/STROKEAHA.111.635334
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center