title: Distance from home to hospital and thrombolytic utilization for acute ischemic stroke.
abstract: Treatment of acute stroke with thrombolytic therapy has been limited because of the narrow treatment window. Distance from home to hospital may affect arrival time and likelihood of receiving thrombolytic therapy for acute stroke. The present study included stroke subjects seen at Barnes Jewish Hospital in 2006-2007, residing in St Louis City/County, who were at home at the time of the stroke (n = 416). A network distance was calculated by mapping the best route from each subject's home to the hospital on a street network grid. Patients were grouped by distance into quintiles, and the group living the closest (group A, first quintile) was compared with the remainder of the cohort (group B). Outcomes of interest were rate of arrival within 3 hours of stroke onset (timely arrival) and rate of thrombolytic administration. The relative rate (RR) of each outcome was calculated for group A versus group B. A multivariate model of thrombolytic administration was created correcting for potential confounders. There was no difference in timely arrival between groups. The rate of thrombolytic administration was 13/100 for group B and 23/100 for group A, for an RR 0.55 (95% confidence interval [CI], 0.31-0.097) for group B versus group A. In the multivariate model, only National Institutes of Health Stroke Scale score was a significant confounder. The adjusted RR of thrombolytic treatment was 0.59 (95% CI, 0.34-0.99) for group B versus group A. Our data indicate that patients living in close proximity to the hospital are more likely to receive thrombolytic therapy for stroke compared with those living farther away. This finding cannot be explained by earlier arrival time.
authors.affiliation: Department of Neurology and Psychiatry, St. Louis University School of Medicine, St. Louis, MO 63104, USA. acharyaa@slu.edu
authors.forename: Aninda B
authors.initials: AB
authors.lastname: Acharya
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Nyirenda
authors.forename: Gary B
authors.initials: GB
authors.lastname: Higgs
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bloomfield
authors.forename: Salvador
authors.initials: S
authors.lastname: Cruz-Flores
authors.forename: Lisa T
authors.initials: LT
authors.lastname: Connor
authors.forename: Jin-Moo
authors.initials: JM
authors.lastname: Lee
authors.forename: Terry L
authors.initials: TL
authors.lastname: Leet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014187:Transportation of Patients / Q000706:statistics & numerical data
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator