Hospital surveillance of acute stroke treatment in Michigan.
BACKGROUND
Modern management of acute stroke, including the use of tissue plasminogen activator (t-PA), requires hospitals to be better prepared for rapid diagnosis and treatment.


METHODS
Surveillance of practice of acute stroke treatment by Michigan hospitals was performed in 1998. We determined variation in hospital preparedness for treatment by number of emergency department visits. Factors associated with hospital use of t-PA were analyzed using logistic regression.


RESULTS
Surveys were returned by 97 (55%) hospitals. Hospitals with a greater number of emergency department visits were significantly more likely to have a clinical pathway, to have given t-PA, and to be better prepared for stroke treatment. After multivariate analysis, greater number of stroke patients per year (P < .001) and availability of skilled intensive care department staff (P = .056) were associated with hospital t-PA use.


CONCLUSIONS
Specific hospital characteristics are associated with t-PA use. Consideration of these may be used to devise new strategies for improved delivery of acute stroke treatment.
Jacobs
Bradley S
BS
Wayne State University/Detroit Medical Center Stroke Program, Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA.
Hickenbottom
Susan L
SL
Reeves
Mathew
M
Janisse
James J
JJ
Chabut
Jean C
JC
Hurst
Rochelle
R
Baker
Patricia
P
Daley
Sheila
S
Levine
Steven R
SR