Published Online
on May 15, 2003

A more recent version of this article appeared on June 1, 2003

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Submitted on December 24, 2002
Accepted on January 16, 2003

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; and 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.

^* To whom correspondence should be addressed. 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

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