Abstract 190: Effect of Stroke Legislation on Emergency Medical Services (EMS) Pre-notification and Thrombolysis Rates for Stroke in Chicago
Background: Many stroke patients are not treated with intravenous tissue plasminogen activator (IV TPA) due to hospital arrival beyond the treatment window. We evaluated the impact that a state law that mandated transportation of acute stroke patients to the nearest stroke center had on EMS pre-notification and thrombolysis.
Methods: We assessed the period before and after the law was implemented (March 1, 2011) among a benchmark group of 10 Primary Stroke Centers and 1 hospital pending stroke certification. Using the Get With The Guidelines-Stroke (GWTG-S) registry, we analyzed data on demographics, onset-to-arrival times, diagnoses, and treatments from these stroke centers comparing March-June 2011 to the same period 1 year earlier. We used chi-square statistics to compare pre- and post-intervention rates of EMS pre-notification and IV TPA utilization and Mann-Whitney tests to compares times.
Results: The number of stroke discharges was 768 (61.8% ischemic stroke) in March-June 2010 and 749 (63% ischemic stroke) in March-June 2011. Demographics including age and sex were not different between the two periods (mean age 65 years and 53% female). EMS mode of arrival increased from 32.4% in 2010 to 37.6% in 2011 (P=0.043). EMS pre-notification was used in 54.5% of patients in 2010 versus 75.2% in 2011 (P<0.001). Onset-to-arrival times decreased from median 200 minutes to 133 minutes (P=0.003). Eleven of 30 (36.7%) ischemic stroke patients arriving with 3 hours were treated with IV tPA for those 3 months in 2010 compared with 30/45 (66.7%)during the same period in 2011 (P=0.017). Door-to-needle (DTN) times were not significantly different (median 87 vs. 86 minutes; 10.0% vs. 11.1 % DTN < 60 minutes).
Conclusions: Implementation of a law with preferential triage of stroke patients to the nearest stroke center in Chicago has shown significant improvements in EMS utilization, EMS pre-notification, a substantial decline in onset-to-arrival times, and a near doubling of IV TPA utilization. State legislation based stroke system organization can significantly improve health care delivery within a very short period of time.
- © 2012 by American Heart Association, Inc.