Acute stroke care in the US: results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry.
OBJECTIVE
The Paul Coverdell National Acute Stroke Registry is being developed to improve the quality of acute stroke care. This article describes key features of acute stroke care from 4 prototype registries in Georgia (Ga), Massachusetts (Mass), Michigan (Mich), and Ohio.


METHODS
Each prototype developed its own sampling scheme to obtain a representative sample of hospitals. Acute stroke admissions were identified using prospective (Mass, Mich) or retrospective (Ga, Ohio) methods. All prototypes used a common set of case definitions and data elements. Weighted site-specific frequencies were generated for each outcome.


RESULTS
A total of 6867 admissions from 98 hospitals were included; the majority were ischemic strokes (range, 52% to 70%) with transient ischemic attack and intracerebral hemorrhage comprising the bulk of the remainder. Between 19% and 26% of admissions were younger than age 60 years, and between 52% and 58% were female. Black subjects varied from 7.1% (Mich) to 30.6% (Ga). Between 20% and 25% of admissions arrived at the emergency department within 3 hours of onset. Treatment with recombinant tissue plasminogen activator (rtPA) was administered to between 3.0% (Ga) and 8.5% (Mass) of ischemic stroke admissions. Of 118 subjects treated with intravenous rtPA, <20% received it within 60 minutes of arrival. Compliance with secondary prevention practices was poorest for smoking cessation counseling and best for antithrombotics.


CONCLUSIONS
A minority of acute stroke patients are treated according to established guidelines. Quality improvement interventions, targeted primarily at the health care systems level, are needed to improve acute stroke care in the United States.
Reeves
Mathew J
MJ
Michigan State University, East Lansing, USA. reevesm@msu.edu
Arora
Shalini
S
Broderick
Joseph P
JP
Frankel
Michael
M
Heinrich
John P
JP
Hickenbottom
Susan
S
Karp
Herbert
H
LaBresh
Kenneth A
KA
Malarcher
Ann
A
Mensah
G
G
Moomaw
Charles J
CJ
Schwamm
Lee
L
Weiss
Paul
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005845:Georgia; D006753:Hospital Records; D006801:Humans; D007262:Infusions, Intravenous; D002546:Ischemic Attack, Transient / Q000628:therapy; D008297:Male; D008404:Massachusetts; D008824:Michigan; D008875:Middle Aged; D009820:Ohio; D010865:Pilot Projects; D011446:Prospective Studies; D011786:Quality Control; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator