Organization of a United States County System for Comprehensive Acute Stroke Care
| Autor: | Stephen Waldman, Anthony Ciabarra, Ken Miller, Elizabeth N. Traynor, Dana Stradling, Nirav Patel, Michael Cummings, David L. Lombardi, David M. Brown, Steven C. Cramer, Richard Dauben, Ignacio M. Carrillo-Nunez, Samuel J. Stratton |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Time Factors Neurology Ambulances Ambulatory Care Facilities California Article Reperfusion therapy Acute care medicine Suspected stroke Intensive care medicine Stroke Emergency medical system Acute stroke Advanced and Specialized Nursing business.industry Ischemic strokes Age Factors medicine.disease Reperfusion Neurology (clinical) Cardiology and Cardiovascular Medicine business Delivery of Health Care |
| Zdroj: | Stroke. 43:1089-1093 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.111.635334 |
| Popis: | Background and Purpose— Organized systems of care have the potential to improve acute stroke care delivery. The current report describes the experience of implementing a county-wide system of spoke-and-hub stroke neurology receiving centers (SNRC) that incorporated several comprehensive stroke center recommendations. Methods— Observational study of patients with suspected stroke of Results— A total of 1360 patients with suspected stroke were evaluated at 9 hub SNRC, of which 553 (40.7%) had a discharge diagnosis of ischemic stroke. Of these 553, intravenous tissue-type plasminogen activator was administered to 110 patients (19.9% of ischemic strokes). Care at the 6 neurointerventional-ready SNRC was a major focus in which 25.1% (99/395) of the patients with ischemic stroke received acute intravenous or intra-arterial reperfusion therapy, and in which provision of such therapies was less common with milder stroke, older age, and Hispanic origin. The door-to-needle time for intravenous tissue-type plasminogen activator met the P =0.0001) when SNRC were neurointerventional-ready. Conclusions— A stroke system that incorporates features of comprehensive stroke centers can be effectively implemented with substantial rates of acute reperfusion therapy administration. Experiences potentially useful to broader implementation of comprehensive stroke centers are considered. |
| Databáze: | OpenAIRE |
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