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Neurology. 2013 Dec 3;81(23):1986-95. doi: 10.1212/01.wnl.0000436946.08647.b5. Epub 2013 Nov 1.

Thrombolytic utilization for ischemic stroke in US hospitals with neurology residency program.

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From the Neurosciences Critical Care Division (Y.M.), Johns Hopkins University, Baltimore, MD; Stroke Center and Departments of Neurology (Y.M., H.C., H.V., and S.R.L.), Pathology (H.C.), and Emergency Medicine (S.R.L.), SUNY Downstate Medical Center, Brooklyn; and Department of Neurology (Y.M., H.V., and S.R.L.), Kings County Hospital Center, Brooklyn, NY.



We aimed to compare the rates of thrombolysis utilization for acute ischemic stroke in hospitals with neurology residency (NR) to those of other teaching (OT) and nonteaching (NT) hospitals.


A retrospective serial cross-sectional cohort study of a nationally representative sample of stroke patients was conducted. Accreditation Council for Graduate Medical Education-accredited NR program-affiliated hospitals in the United States were cross-matched to the hospitals in the Nationwide Inpatient Sample from 2000 to 2010. ICD-9-CM codes were used for case ascertainment.


A total of 712,433 adult ischemic stroke patients from 6,839 hospital samples were included, of whom 10.1%, 29.1%, and 60.8% were treated in NR, OT, and NT hospitals, respectively. Stroke patients in NR received thrombolysis more frequently (3.74% ± 0.24% [standard error]) than in OT (2.28% ± 0.11%, p < 0.001) and NT hospitals (1.44% ± 0.06%, p < 0.001). The adjusted odds ratios (ORs) of thrombolysis rates in NR vs OT and NR vs NT increased with each decade increment in age. In multivariate analysis, NR was independently predictive of higher thrombolysis rate (adjusted OR 1.51; 95% confidence interval [CI] 1.44-1.59 [NR vs OT], and adjusted OR 1.82; 95% CI 1.73-1.91 [NR vs NT]).


Acute stroke care in NR hospitals is associated with an increased thrombolytic utilization. The disparities between the thrombolysis rate in NR and that in OT and NT hospitals are greater among elderly patients.

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