This Article Full Text Full Text (PDF) All Versions of this Article: 34/6/e55    most recent 01.STR.0000073789.12120.F3v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lattimore, S. U. Articles by Warach, S. Search for Related Content PubMed PubMed Citation Articles by Lattimore, S. U. Articles by Warach, S. Related Collections Cerebrovascular disease/stroke Fibrinolysis Clinical Studies Acute Cerebral Infarction Emergency treatment of Stroke Computerized tomography and Magnetic Resonance Imaging Thrombolysis

(Stroke. 2003;34:e55.)
© 2003 American Heart Association, Inc.

Research Reports

Impact of Establishing a Primary Stroke Center at a Community Hospital on the Use of Thrombolytic Therapy

The NINDS Suburban Hospital Stroke Center Experience

Susan Unipan Lattimore, BSN, CNRN; Julio Chalela, MD; Lisa Davis, MSN; Thomas DeGraba, MD; Mustapha Ezzeddine, MD; Joseph Haymore, MS, ACNP; Paul Nyquist, MD; Alison E. Baird, MD, PhD; John Hallenbeck, MD Steven Warach, MD, PhD

From the Stroke Branch (S.U.L., J.C., L.D., A.E.B., J.H., S.W.), National Institute of Neurological Disorders and Stroke, Bethesda, Md; The Clinical Stroke Research Unit (T.D.), Neurology Department, National Naval Medical Center, Bethesda, Md; the Departments of Neurology/Neurosurgery (M.E.), Emory University School of Medicine, Atlanta, Ga; the Center for Neuroscience Services (J.H.), Washington Adventist Hospital, Takoma Park, Md; and the Stroke Program (P.N.), INOVA Fairfax Hospital, Falls Church, Va.

Correspondence to Steven Warach, MD, PhD, National Institute of Neurological Disorders and Stroke, 10 Center Dr, MSC 1063, Building 10, Room B1D733, Bethesda, MD 20892-1063. E-mail Warachs{at}ninds.nih.gov

Background and Purpose— To increase the proportion of ischemic stroke patients treated with thrombolytic therapy, the establishment of primary stroke centers in community hospitals has been advocated. We evaluated the use of thrombolytic therapy before and after institution of a primary stroke center in a community hospital.

Methods— The availability of an on-call stroke emergency response team was the only significant additional resource required for this hospital. All eligible patients were treated with intravenous tissue plasminogen activator (tPA). The number of patients with cerebrovascular disease, number and proportion of patients treated with tPA, times to treatment, and patient outcomes were recorded during the first 2 years of the stroke center.

Results— During the 12 months before institution of the stroke center, 3 ischemic stroke patients (1.5%) were treated with tPA. During the 2-year period of around-the-clock coverage, 44 of 420 ischemic stroke patients (10.5%) were treated with intravenous tPA, a significant increase in tPA use (P<0.0001).

Conclusions— Establishment of a primary stroke center at a community hospital resulted in a substantial increase in the proportion of patients receiving thrombolytic therapy for ischemic stroke. If this experience is generalized, the beneficial impact of primary stroke centers on stroke outcomes and costs to the healthcare system may be substantial.

Key Words: emergency medical services • hospital planning • stroke units • stroke, acute • thrombolytic therapy

This article has been cited by other articles:

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]

				Part 9: Adult Stroke Circulation, December 13, 2005; 112(24_suppl): IV-111 - IV-120. [Full Text] [PDF]

				L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, P. W. Duncan, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Circulation, March 1, 2005; 111(8): 1078 - 1091. [Full Text] [PDF]

				California Acute Stroke Pilot Registry (CASPR) Inv Prioritizing interventions to improve rates of thrombolysis for ischemic stroke Neurology, February 22, 2005; 64(4): 654 - 659. [Abstract] [Full Text] [PDF]