Abstract 193: IV TPA Administration to Eligible Patients at Certified Primary Stroke Centers
Introduction: The use of IV TPA at Primary Stroke Centers (PSCs) is a key performance metric that can greatly impact patient outcomes after acute ischemic stroke. Concerns remain about whether PSCs administer IV TPA to most eligible patients.
Methods: We used data from PSCs certified by The Joint Commission (TJC) from 2008 to 2011. Patients who presented within 2 hours of ischemic stroke onset were included if they met a list of eligibility criteria for IV TPA consistent with current guidelines.Results were further analyzed based on several hospital characteristics, including teaching status, urban vs rural setting, and number of certification cycles.
Results: Data were available from 34,909 patients at 842 hospitals. The overall rate of TPA use in eligible patients was 81% (28269 of 34909 patients). From 2008 to 2011 the rate of TPA use increased from 79.4% to 83.5% (P < 0.0001). The rate of TPA use at teaching hospitals (n=455) was always greater than at non-teaching hospitals (n=367) overall (82% vs 79%, P < 0.001) and each year (80.4% vs 77.6%, 2008; 82.6% vs 80.2%, 2009; 82.3% vs 77.9%, 2010; 84.7% vs 81.4%, 2011; P < 0.005 for all comparisons). The rate of TPA use always increased with the number of certification cycles that a hospital had completed (absolute increase one cycle vs 4 cycles, 20% in 2008; 12.1% 2009; 12.9% 2010; 5.6% 2011; P < 0.004 for all comparisons). The use of TPA was higher at the 783 urban hospitals compared with the 39 rural hospitals (81.3% vs 72.5%, P < 0.001).
Conclusions: The rate of IV TPA use in eligible patients has increased from 2008 through 2011, and is higher the longer a hospital has been a PSC, and at teaching and urban facilities. Overall PSCs have a high rate of IV TPA administration.
- © 2012 by American Heart Association, Inc.