Abstract NS2: A Comparison of IV t-PA Administration between Critical Access Hospitals and a Primary Stroke Center
Background: Critical access hospitals (CAH) and small community hospitals increase the availability of intravenous tissue plasminogen activator (IV t-PA) in rural areas. However, are their quality control measures and outcomes comparable to a Primary Stroke Center (PSC) functioning as a hub hospital? A comparison of quality control and protocol deviations, as well as outcome measures, of t-PA administered at CAHs to a PSC hospital was undertaken.
Methods: A retrospective chart review of 35 cases of IV t-PA administered in 2012 was completed, including age and gender, initial NIHSS, door to needle time (DTN), protocol deviations, the presence of hemorrhagic transformation, and discharge destinations.
Results: A total of 35 patients received IV t-PA_21 at CAHs and 14 at the PSC hospital in the first 7 months of 2012. The mean age of the CAH patients was 59.33 + 13.8 with 59% female; the mean age of the patients at the PSC hospital was 67.21 + 13.1 with 35% female. The initial NIHSS was lower, but not statistically significant (p=0.074) at CAHs_9.94 compared with the PSC hospital NIHSS of 14.31. The mean DTN time was significantly (p=0.026) longer at the CAHs--104.12 minutes, compared to 64.71 minutes at the PSC hospital, with only 23% of patients receiving IV t-PA within the goal of 60 minutes. At the PSC hospital 36% of patients received t-PA within 60 minutes. The hemorrhagic transformation rate at the CAHs was 18% compared with 7% at the PSC hospital. Protocol deviations were similar between the 2 populations. Discharge destinations varied between CAHs and the PSC hospital with 30% of stroke patients from the CAHs discharged home and 24.2% transferred to in-patient rehab; compared with 15.2% from the PSC discharged home and 6.1% to rehab.
Discussion: CAHs were designed to function as an integral link to provide health care to rural communities. The communities served benefit when CAHs collaborate with Regional referral centers. The significant difference in IV t-PA administration between CAHs and a PSC hospital demonstrate the on-going need for collaboration and education.
- © 2012 by American Heart Association, Inc.