Hospital arrival time and intravenous t-PA use in US Academic Medical Centers, 2001-2004.
OBJECTIVE
Prompt care-seeking behavior is a focus of US national public stroke educational campaigns. We determined whether the time between symptom onset and hospital arrival and the receipt of intravenous tissue-type plasminogen activator (IV t-PA) changed for ischemic stroke patients evaluated at US academic centers between 2001 and 2004.


METHODS
Medical records were abstracted for consecutive ischemic stroke patients admitted from the Emergency Department within 48 hours of symptom onset at 35 academic medical centers participating in the University HealthSystem Consortium Ischemic Stroke Benchmarking Project between January 1, 2001 and March 31, 2001, and 32 centers between January 1, 2004 and June 30, 2004. Demographic and clinical characteristics of patients who presented within and after 2 hours of symptom onset were compared. Multivariate logistic regression was used to compare time to arrival by year and to identify patient characteristics associated with earlier hospital arrival.


RESULTS
The study included 428 patients from 2001 and 481 from 2004. Although there was no difference in the percentage of patients who arrived within 2 hours between the 2 periods (37% in 2001 vs 38% in 2004, P=0.63), the percentage of these patients treated with IV t-PA increased (14.0% to 37.5%, P<0.0001). In risk-adjusted analysis, black patients had a lower odds of arriving within 2 hours (odds ratio=0.55; 95% CI, 0.39 to 0.78), whereas those with severe strokes were more likely to arrive promptly (odds ratio=2.17; 95% CI, 1.49 to 3.15).


CONCLUSIONS
There was no change in the proportion of stroke patients arriving at hospitals within 2 hours of symptom onset between 2001 and 2004; however, the rate of IV t-PA use increased, indicating system-level improvements of in-hospital care.
Lichtman
Judith H
JH
Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA. Judith.Lichtman@yale.edu
Watanabe
Emi
E
Allen
Norrina B
NB
Jones
Sara B
SB
Dostal
Jackie
J
Goldstein
Larry B
LB
D000046:Academic Medical Centers / Q000706:statistics & numerical data / Q000639:trends*; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D004632:Emergency Medical Services / Q000706:statistics & numerical data / Q000639:trends*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007275:Injections, Intravenous / Q000706:statistics & numerical data / Q000639:trends; D020767:Intracranial Thrombosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000706:statistics & numerical data / Q000639:trends; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data / Q000639:trends*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014187:Transportation of Patients / Q000706:statistics & numerical data / Q000639:trends; D014481:United States; D044465:White People / Q000706:statistics & numerical data
D010959:Tissue Plasminogen Activator