Organization of a U.S. County System for Comprehensive Acute Stroke Care
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Organization of a U.S. County System for Comprehensive Acute Stroke Care

  • Author(s): Cramer, Steven C.
  • Stradling, Dana
  • Brown, David M.
  • Carrillo-Nunez, Ignacio M.
  • Ciabarra, Anthony
  • Cummings, Michael
  • Dauben, Richard
  • Lombardi, David L.
  • Patel, Nirav
  • Traynor, Elizabeth N.
  • Waldman, Stephen
  • Miller, Ken
  • Stratton, Samuel J.
  • et al.
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 countywide 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 <5 hours duration transported by Emergency Medical System personnel to an SNRC during the first year of this system.

RESULTS

A total of 1,360 patients with suspected stroke were evaluated at 9 hub SNRCs, of which 553 (40.7%) had a discharge diagnosis of ischemic stroke. Of these 553, intravenous (IV) tPA was given to 110 patients (19.9% of ischemic strokes). Care at the 6 neurointerventional-ready SNRC was a major focus, where 25.1% (99/395) of the patients with ischemic stroke received acute IV or intraarterial reperfusion therapy, and where provision of such therapies was less common with milder stroke, higher age, and Hispanic origin. The door-to-needle time for IV tPA met the <60 minute target in only 25% of patients and was 37% longer (p=0.0001) when SNRCs were neurointerventional-ready.

CONCLUSIONS

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

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