Proportion of Patients Treated With Thrombolysis in a Centralized Versus a Decentralized Acute Stroke Care Setting

• DOI: 10.1161/strokeaha.111.641795
• Publication Date: 2012-03-17T04:27:47Z
• Authors: Maarten M.H. Lahr; Gert-Jan Luijckx; Patrick C.A.J. Vr...; Durk-Jouke van de...; Erik Buskens
• Keywords: Stroke; Fibrinolytic agent

Background and Purpose— Today, treatment of acute stroke consists tissue-type plasminogen activator (tPA), admission to a unit, aspirin. Although tPA is the most effective, there substantial undertreatment. Centralized care may affect rate, timing, outcome thrombolysis compared decentralized in community hospitals. The present study aimed assess impact organizational models on proportion patients undergoing treatment. Methods— A prospective, multicenter, observational among 13 hospitals North Netherlands was conducted. In centralized model, for 4 administered 1 center. model comprised 9 Primary treated with tPA. Secondary measures were arriving within 4.5 hours, safety, 90-day functional outcome, onset-to-door, door-to-needle, onset-to-needle times. Potential confounders adjusted using logistic regression analysis. Results— Two hundred eighty-three 801 ischemic enrolled settings. Numbers 62 (21.9%) 113 (14.1%) (OR, 1.72; 95% CI, 1.22–2.43). Adjusting potential did not alter results 2.03; 1.39–2.96). setting, significantly more arrived at hospital 4.5-hour time window ( P <0.01), shorter door-to-needle times reached (35 versus 47 minutes). Other secondary differ across setting. Conclusions— demonstrate 50% increased likelihood Prehospital factors seem contribute this result.