Abstract T P144: Rural Stroke System Development and Patterns of Arrival
Introduction: The Iowa Stroke Registry (ISR) is one of the Paul Coverdell Registries of the Centers for Disease Control. Its goal is to assess the performance of the Iowa Stroke System and to conduct system improvement to improve stroke care and outcomes. One of the major challenges in rural state is acute intervention in a geographically dispersed population and transport to definitive care.
Methods: The Iowa Stroke Registry was established in 2007 with data collection from 32 comprehensive, primary and stroke capable hospitals in Iowa beginning in 2009. To date over 10,000 patients have been enrolled.
Arrival to the ISR was characterized as via EMS, private vehicle or transfer from another facility. Factors related to stroke symptoms and presentation and time to arrival from last known well were examined by arrival mode.
Categorical analysis was done using a Chi-Square Test with an alpha of 0.05.
Results: To date 39% of patients with stroke came directly by ambulance, 35% by private vehicle and 25% transferred from local hospitals. Of EMS transported patients were 94% were admitted through the ER; 13% of private vehicle and 32% of transfer patients were directly admitted to inpatient beds. Admission symptoms were similar regardless of transport mode with 64% of patients with weakness, 10% speech difficulties, 3% vision abnormalities and 28% with aphasia. Ambulation with assistance or unable to ambulate was highest in private vehicle patients (8.6%)(p<.05). Transfer (median=347 minutes) and private vehicle (median=408) were significantly longer than EMS arrivals (median=222). As the system developed, the percentage of transfer patients significantly increased over time.
Conclusions: With nearly one-third of patients still arriving by private vehicle there is a need for further public education. Increase in transfers demonstrate the effect of stroke system development. These data from the ISR provide information for a wide-ranging stroke education program by the Coverdell Registry and Stroke Task Force committees and stakeholders in Iowa.
Author Disclosures: J.C. Torner: Research Grant; Modest; CDC Coverdell Stroke Registry, NIH NIA. E. Rindels: None. A. Overton: None. E. Leira: Research Grant; Modest; NIH NINDS StrokeNet. M. Mueller: None. M. Nugent: None. B. Spear: None.
- © 2015 by American Heart Association, Inc.