Proportion of Patients Treated With Thrombolysis in a Centralized Versus a Decentralized Acute Stroke Care Setting
- 1 May 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 43 (5), 1336-1340
- https://doi.org/10.1161/strokeaha.111.641795
Abstract
Today, treatment of acute stroke consists of tissue-type plasminogen activator (tPA), admission to a stroke unit, and aspirin. Although tPA treatment is the most effective, there is substantial undertreatment. Centralized care may affect rate, timing, and outcome of thrombolysis compared to decentralized treatment in community hospitals. The present study aimed to assess the impact of organizational models on the proportion of patients undergoing tPA treatment. A prospective, multicenter, observational study among 13 hospitals in the North of the Netherlands was conducted. In the centralized model, tPA treatment for 4 hospitals was administered in 1 stroke center. The decentralized model comprised 9 community hospitals. Primary outcome was the proportion of patients treated with tPA. Secondary outcome measures were proportion of patients arriving within 4.5 hours, safety, 90-day functional outcome, and onset-to-door, door-to-needle, and onset-to-needle times. Potential confounders were adjusted using logistic regression analysis. Two hundred eighty-three and 801 ischemic stroke patients were enrolled in the centralized and decentralized settings. Numbers of patients treated with tPA were 62 (21.9%) and 113 (14.1%) (OR, 1.72; 95% CI, 1.22–2.43). Adjusting for potential confounders did not alter results (OR, 2.03; 95% CI, 1.39–2.96). In the centralized setting, significantly more patients arrived at the hospital within the 4.5-hour time window ( P <0.01), and shorter door-to-needle times were reached (35 versus 47 minutes). Other secondary outcome measures did not differ across setting. In a centralized setting, the results demonstrate a 50% increased likelihood of treatment. Prehospital factors seem to contribute to this result.Keywords
This publication has 27 references indexed in Scilit:
- Effectiveness of Primary and Comprehensive Stroke CentersStroke, 2010
- Semi-intensive stroke unit versus conventional care in acute ischemic stroke or TIA — A prospective study in GermanyJournal of the Neurological Sciences, 2009
- Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic StrokeThe New England Journal of Medicine, 2008
- Calling 911 in Response to StrokeStroke, 2008
- Specialized stroke services: A meta-analysis comparing three models of careCerebrovascular Diseases, 2006
- Estimating the Number of Stroke Patients Eligible for Thrombolytic Treatment if Delay Could Be AvoidedCerebrovascular Diseases, 2006
- Acute Stroke Care in the USStroke, 2005
- A study of the workload and effectiveness of a comprehensive acute stroke serviceJournal of Neurology, Neurosurgery & Psychiatry, 2005
- Utilization of Intravenous Tissue Plasminogen Activator for Acute Ischemic StrokeArchives of Neurology, 2004
- Tissue Plasminogen Activator for Acute Ischemic StrokeThe New England Journal of Medicine, 1995