(Stroke. 2001;32:1832.)
© 2001 American Heart Association, Inc.
Original Contributions |
Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community Hospitals
From the Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy (S.D.R., D.K.B.), Departments of Neurology (S.C.C.), Radiology (J.G.J.), Neurological Surgery (J.G.J.), and Health Services (J.G.J.), School of Medicine, and the Schools of Nursing and Medicine (K.M.), University of Washington, Seattle, Wash; and HBS International, Inc (K.M.), Bellevue, Wash.
Correspondence to Shelby D. Reed, PhD, Duke Clinical Research Institute, PO Box 17969, 2400 Pratt St, Durham, NC 27715. E-mail reed0034{at}mc.duke.edu
Background and Purpose—— Most analyses of intravenous tissue plasminogen activator (IV tPA) use for acute stroke in routine practice have been limited by sample size and generally restricted to patients treated in large academic medical facilities. In the present study, we sought to estimate among community hospitals the use of IV tPA and to identify factors associated with the use of IV tPA and inpatient mortality.
Methods—— We evaluated a retrospective cohort of 23 058 patients with ischemic stroke from 137 community hospitals.
Results—— Three hundred sixty-two (1.6%) patients were treated with IV tPA, and 9.9% of those patients died during the hospitalization period. In 35.0% of the hospitals, no patients were treated with IV tPA, whereas 14.6% of hospitals treated 
3.0% with IV tPA. After control for multiple factors, younger patients, more severely ill patients (OR 2.02, 95% CI 1.36 to 3.01), and patients treated in rural hospitals (OR 1.80, 95% CI 0.99 to 3.26) were more likely to receive IV tPA, whereas black patients were less likely (OR 0.54, 95% CI 0.31 to 0.95). There also was a trend showing that women were less likely to receive IV tPA (OR 0.84, 95% CI 0.69 to 1.03). Factors associated with an increased odds of inpatient mortality included receipt of IV tPA among men (OR 2.81, 95% CI 1.72 to 4.58) and increased age. Black patients were 27% less likely to die during hospitalization (95% CI 0.60 to 0.90).
Conclusions—— In this large, retrospective evaluation of community hospital practice, the use IV tPA and inpatient mortality rates among IV tPA–treated patients were consistent with those of other studies. The likelihood of receiving IV tPA varies by race, age, disease severity, and possibly gender. These factors may influence mortality rates.
Editorial Comment
Director, OSF Stroke Network, Clinical Assistant Professor, Neurology & Clinical Pharmacology, University of Illinois College of Medicine at Peoria, Chair, ASA Peoria Tri-County Operation Stroke, Peoria, Illinois
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