Abstract 2345: Do the 10 PSC Measures Improve Outcome in Stroke Patients
Background and Purpose- While many healthcare systems are currently attempting to achieve Primary Stroke Center (PSC) certification, no study has evaluated the impact of the 10 PSC measures on long term outcome. The purpose of this study was to determine the compliance with and association between the 10 PSC measures and 90 day outcome in a certified PSC vs a non-certified center.
Methods- A retrospective review of prospectively collected data was performed. Analysis included patients presenting between 01/01/2009 and 12/31/2010 as stroke codes to the University of California San Diego Medical Center (PSC) and Sharp Hospital (non-PSC, practicing under Brain Attack Coalition (BAC) guidelines). Both centers utilize the same acute ED stroke code team, though decisions to activate these codes and inpatient stroke code protocols are different. All patients or surrogates provided consent and had 90 day outcome data available. Analysis plan included the statistical association of each PSC measure with stroke outcome (90 day mRS) using Fisher's Exact. Data analysis plan also included comparing 90 day outcome for a PSC center to those of a non-PSC center using chi squared. Good outcome was defined as mRS 0-2 at 90 days.
Results- 138 patients were included in the analysis (UCSD=52; Sharp=86). 47.3% were female. There was no significant difference in good outcome (p>0.99) or mortality (p=0.309) between the sites. Significant differences existed for compliance with 1) “DVT prophylaxis” (p=0.004); 2) “antiplatelet on discharge” (p<0.001); 3) “thrombolytics administered” (p<0.001); 4)“stroke education” (p<0.001); 5) “rehab considered” (p=0.001) and 6) “lipid evaluation” (p=0.002), all in favour of the PSC. “Antiplatelet on discharge” (p=0.001), “thrombolytics administered” (p=0.011), and “lipid evaluation” (p=0.012) were the only PSC measures that were significant predictors of 90 day outcome.
Conclusions- This study found that the PSC provided significantly more compliance with the 10 PSC measures. Only 3 of the PSC measures are independent predictors of outcome at 90 days. It is vital to re-examine the PSC requirements to ensure that guidelines are in place to significantly impact patient outcome.
- © 2012 by American Heart Association, Inc.