Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

Frontiers in Neurology

卷:10

Samuel Stratton¹  Marc Eckstein²  Theodore T. Wang³  Nerses Sanossian³  May Kim-Tenser³  Lily Vartanyan³  Scott Hamilton⁴  Jeffrey L. Saver⁵  David S. Liebeskind⁵  Sidney Starkman⁵  Franklin D. Pratt⁶  Robin Conwit⁷  Kristina Shkirkova⁸ 

[1] Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, United States;

[2] Department of Emergency Medicine, University of Southern California, Los Angeles, CA, United States;

[3] Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States;

[4] Department of Neurology, Stanford Stroke Center, School of Medicine, Stanford University, Palo Alto, CA, United States;

[5] Department of Neurology, UCLA Comprehensive Stroke Center, Los Angeles, CA, United States;

[6] Los Angeles County Department of Public Health, Los Angeles, CA, United States;

[7] National Institutes of Health, Bethesda, MD, United States;

[8] Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States;

关键词: stroke;    primary stroke center;    stroke center certification;    acute ischemic stroke;    cerebral ischemia;    tPA;   

DOI  :  10.3389/fneur.2019.01396

来源: DOAJ

【 摘 要 】

Background and Purpose: Primary stroke center (PSC) certification is associated with improvements in stroke care and outcome. However, these improvements may reflect a higher baseline level of care delivery in hospitals eventually achieving certification. This study examines whether advancements in acute stroke care at PSCs are due to certification or factors intrinsic to the hospital.Methods: Data was obtained from the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) trial with participation of 40 Emergency Medical System agencies, 315 ambulances, and 60 acute receiving hospitals in Los Angeles and Orange Counties. Subjects were transported to one of three types of destinations: PSC certified hospitals (PSCs), hospitals that were not PSCs at time of enrollment but would later become certified (pre-PSCs), and hospitals that would never be certified (non-PSCs). Metrics of acute stroke care quality included time arrival to imaging, use of intravenous tPA, and arrival to treatment.Results: Of 1,700 cases, 856(50%) were at certified PSCs, 529(31%) were at pre-PSCs, and 315 (19%) were at non-PSCs. Mean (SD) was 33min (±76.1) at PSCs, 47(±86.6) at pre-PSCs, and 49(±71.7) at non-PSCs. Of 1,223 cerebral ischemia cases, rate of tPA utilization was 43% at PSCs, 27% at pre-PSCs, and 28% at non-PSCs. Mean ED arrival to thrombolysis was 71(±32.7) at PSC, 98(±37.6) at pre-PSC, and 95(±45.0) at non-PSCs. PSCs had improved time to imaging (p = 0.014), percent tPA use (p < 0.001), and time to treatment (p = 0.003).Conclusions: Stroke care at hospitals prior to PSC certification is equivalent to care at non-PSCs.Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT00059332.

【 授权许可】

Unknown