title: Changing demographics at a comprehensive stroke center amidst the rise in primary stroke centers.
abstract: BACKGROUND
  The creation of The Joint Commission primary stroke centers (PSCs) has increased access to acute stroke care in metropolitan areas. We hypothesized that the rise in PSCs in the Houston area was associated with demographic changes and decreased trial enrollment at our comprehensive stroke center.
  
  
  METHODS
  Consecutive admissions to the UT Houston stroke team from January 2005 to June 2011 were reviewed for demographic and clinical information. Patient characteristics were compared across years. Logistic regression was performed to assess the odds of admission per year.
  
  
  RESULTS
  During the 6.5-year study period, there were 6623 admissions. Admissions increased each year. The proportion of patients transferred from other hospitals to our Comprehensive Stroke Center increased from 24.6% in 2005 to 45.5% in 2011. The number of The Joint Commission PSCs in the greater Houston area increased from 2 to 15. The percentage of large artery occlusions fell from 32.9% in 2005 to a low of 16.4% in 2010, whereas minor strokes (National Institutes of Health Stroke Scale, 0-5) increased from 37.4% in 2005 to 48.6% in 2011. Among stroke patients presenting within 3 hours, study enrollment fell from 45.8% in 2005 to 19.3% in 2011.
  
  
  CONCLUSIONS
  We observed a temporal association between the changes in our patient demographics and the number of The Joint Commission PSCs in Houston. The number of large artery occlusions decreased over time, whereas the number of mild strokes increased. In addition, the number of patients enrolled into clinical trials substantially decreased. Increased access to stroke care at PSCs may be associated with changes in patient demographics and clinical trial enrollment at our center.
authors: Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education, School of Public Health, Department of Epidemiology, School of Medicine, University of Alabama atBirmingham, Birmingham, AL, USA.
authors: Karen C
authors: KC
authors: Albright
authors: Amelia K
authors: AK
authors: Boehme
authors: Michael T
authors: MT
authors: Mullen
authors: Samantha
authors: S
authors: Seals
authors: James C
authors: JC
authors: Grotta
authors: Sean I
authors: SI
authors: Savitz
mesh_terms: D002545:Brain Ischemia / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy*; D015331:Cohort Studies; D003710:Demography; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008297:Male; D010360:Patient Transfer; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy*; D013781:Texas; D013997:Time Factors