Abstract 194: Impact of Primary Stroke Centers On a Comprehensive Stroke Center
Introduction: The creation of primary stroke centers (PSCs) accredited by The Joint Commission (TJC) has increased access of care to a higher number of patients with acute ischemic stroke (AIS) in greater metropolitan areas. However, PSCs in many regions of the US do not conduct clinical trials in acute stroke. We hypothesized that creation of PSCs in the greater Houston area has led to changes in the demographics of our stroke admissions.
Methods: Consecutive patients admitted to the UT Houston stroke team from 1/1/2005-12/30/2010 were screened. Records were reviewed for demographic and clinical information. Patient characteristics were compared among years using Chi-square and Kruskal-Wallis.
Results: Over the 5 year period, 6,036 patients were admitted to our stroke service. The number of admissions increased from 674 in 2005 to 1,234 in 2010. Transfers from outside hospitals trended up from 24.6% (n=166) of all admissions in 2005 to 41.8% (n=516) in 2010. With the increase in transfers, the number of ICH transfer cases has increased over the past 5 years (Fig). Among all ischemic strokes, the percent of large artery occlusions (LAOs) presenting within 6-hrs from symptom onset fell from 34.3% (69/201) in 2005 to 16.4% (45/274) in 2010. Minor strokes (NIHSS 0-5) have increased from 37.4% (141/377) in 2005 to 42.5% (239/562). Overall, IV t-PA treatment rates remained unchanged, ranging from 29.7% to 37.0% from 2005 to 2010 (p=.490). Among AIS patients presenting within 6-hrs, study enrollment fell from 41.8% (84/201) in 2005 to 26.3% (72/274) in 2010. Figure 1 shows the changing demographics of our admissions plotted against the number of hospitals that have attained TJC PSC accreditation.
Conclusion: As PSCs have arisen in the greater Houston area, we have seen a shift in the demographics of our stroke admissions including an escalating number of transfer patients. Among ischemic stroke patients, the number of LAOs has been decreasing overtime and the number of mild strokes has been increasing. These results are likely due, in part, to the transport of patients by EMS to the nearest PSCs who then preferentially request transfer of ICH cases to comprehensive stroke centers (CSCs). Consequently, the number of patients enrolled into clinical trials (the majority of which have been based on ischemic stroke and LAOs) has substantially decreased at our center. PSCs should be encouraged by accreditation committees to work with CSCs and participate in clinical research. To that end, PSCs may need investments in staff and resources to conduct clinical trials testing new stroke therapies.
- © 2012 by American Heart Association, Inc.