Impact of establishing a primary stroke center at a community hospital on the use of thrombolytic therapy: the NINDS Suburban Hospital Stroke Center experience.
OBJECTIVE
To increase the proportion of ischemic stroke patients treated with thrombolytic therapy, the establishment of primary stroke centers in community hospitals has been advocated. We evaluated the use of thrombolytic therapy before and after institution of a primary stroke center in a community hospital.


METHODS
The availability of an on-call stroke emergency response team was the only significant additional resource required for this hospital. All eligible patients were treated with intravenous tissue plasminogen activator (tPA). The number of patients with cerebrovascular disease, number and proportion of patients treated with tPA, times to treatment, and patient outcomes were recorded during the first 2 years of the stroke center.


RESULTS
During the 12 months before institution of the stroke center, 3 ischemic stroke patients (1.5%) were treated with tPA. During the 2-year period of around-the-clock coverage, 44 of 420 ischemic stroke patients (10.5%) were treated with intravenous tPA, a significant increase in tPA use (P<0.0001).


CONCLUSIONS
Establishment of a primary stroke center at a community hospital resulted in a substantial increase in the proportion of patients receiving thrombolytic therapy for ischemic stroke. If this experience is generalized, the beneficial impact of primary stroke centers on stroke outcomes and costs to the healthcare system may be substantial.
Stroke Branch, National Institute of Neurological Disorders and Stroke, 10 Center Dr, MSC 1063, Building 10, Room B1D733, Bethesda, Md 20892-1063, USA.
Susan Unipan
SU
Lattimore
Julio
J
Chalela
Lisa
L
Davis
Thomas
T
DeGraba
Mustapha
M
Ezzeddine
Joseph
J
Haymore
Paul
P
Nyquist
Alison E
AE
Baird
John
J
Hallenbeck
Steven
S
Warach
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D019091:Critical Pathways; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008396:Maryland; D008403:Mass Screening; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration*; D010865:Pilot Projects; D020127:Recovery of Function / Q000187:drug effects; D020521:Stroke / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use; D014218:Triage / Q000706:statistics & numerical data; D000078329:Workforce
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator