title: Intravenous thrombolysis for stroke increases over time at primary stroke centers.
abstract: OBJECTIVE
  We evaluated the impact that duration as a primary stroke center (PSC) had on tissue-type plasminogen activator (tPA) utilization for acute ischemic stroke.
  
  
  METHODS
  A retrospective analysis of the Illinois Hospital Association CompData was performed identifying those patients with primary discharge diagnosis of acute ischemic stroke based on International Classification of Diseases version 9 codes. We assessed utilization of tPA by International Classification of Diseases version 9 procedure code (99.10). We categorized patients as cared for at non-PSC, PSC >1 year before, ≤1 year before, ≤1 year after, and >1 year after certification. We used generalized estimating equations to calculate adjusted odds ratios for tPA utilization by PSC category.
  
  
  RESULTS
  Among 119,539 acute ischemic stroke patients (mean age, 72 years; 55.2% women), tPA use was 1.9% but increased by PSC category (P<0.001): (1) non-PSC 0.9%; (2) >1 year before PSC certification 1.4%; (3) ≤1 year before certification 3.2%; (4) ≤1 year after certification 4.3%; and (5) >1 year after certification 6.5%. Adjusting for age, insurance status, admission source, year of study, region of Illinois, and hospital bed size, the odds of tPA utilization increased with advancing stage of PSC certification (highest category: adjusted odds ratio, 2.37; 95% confidence interval, 1.52-3.71).
  
  
  CONCLUSIONS
  Although increasing over time, stroke thrombolysis is strongly impacted by the PSC certification process. Rather than waning or stagnating, tPA utilization increases at PSC from the earliest phases of preparation through certification and subsequent maintenance.
authors.affiliation: Rush University Medical Center, Department of Neurological Sciences, Chicago, Illinois, USA. shyam_prabhakaran@rush.edu
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.forename: Maggie
authors.initials: M
authors.lastname: McNulty
authors.forename: Kathleen
authors.initials: K
authors.lastname: O'Neill
authors.forename: Bichun
authors.initials: B
authors.lastname: Ouyang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D002568:Certification; D015331:Cohort Studies; D016001:Confidence Intervals; D004363:Drug Utilization; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D006268:Health Facilities / Q000592:standards / Q000706:statistics & numerical data*; D006276:Health Facility Size; D006801:Humans; D007087:Illinois; D007275:Injections, Intravenous; D038801:International Classification of Diseases; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator