Acute Stroke Care in the US Results from 4 Pilot Prototypes of the Paul Coverdell National Acute Stroke Registry

• Published in: Stroke (1970) Vol. 36; no. 6; pp. 1232 - 1240
• Main Authors: Reeves, Mathew J, Arora, Shalini, Broderick, Joseph P, Frankel, Michael, Heinrich, John P, Hickenbottom, Susan, Karp, Herbert, LaBresh, Kenneth A, Malarcher, Ann, Mensah, G, Moomaw, Charles J, Schwamm, Lee, Weiss, Paul
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.06.2005
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain Ischemia - pathology; Cerebral Hemorrhage - therapy; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Georgia; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hospital Records; Humans; Infusions, Intravenous; Ischemic Attack, Transient - therapy; Male; Massachusetts; Medical sciences; Michigan; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Ohio; Pharmacology. Drug treatments; Pilot Projects; Prospective Studies; Quality Control; Recombinant Proteins - therapeutic use; Registries; Retrospective Studies; Stroke - epidemiology; Stroke - prevention & control; Stroke - therapy; Thrombolytic Therapy - methods; Time Factors; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; United States; Vascular diseases and vascular malformations of the nervous system; Ohio; Georgia; United States; Massachusetts; Michigan; Vascular disease; Stroke; Nervous system diseases; stroke, acute; Central nervous system disease; Cardiovascular disease; registries; quality of healthcare; Cerebrovascular disease; health care; Cerebral disorder
• DOI: 10.1161/01.STR.0000165902.18021.5b
• ISSN: 0039-2499; 1524-4628

Background and Purpose— The Paul Coverdell National Acute Stroke Registry is being developed to improve the quality of acute stroke care. This article describes key features of acute stroke care from 4 prototype registries in Georgia (Ga), Massachusetts (Mass), Michigan (Mich), and Ohio. Methods— Each prototype developed its own sampling scheme to obtain a representative sample of hospitals. Acute stroke admissions were identified using prospective (Mass, Mich) or retrospective (Ga, Ohio) methods. All prototypes used a common set of case definitions and data elements. Weighted site-specific frequencies were generated for each outcome. Results— A total of 6867 admissions from 98 hospitals were included; the majority were ischemic strokes (range, 52% to 70%) with transient ischemic attack and intracerebral hemorrhage comprising the bulk of the remainder. Between 19% and 26% of admissions were younger than age 60 years, and between 52% and 58% were female. Black subjects varied from 7.1% (Mich) to 30.6% (Ga). Between 20% and 25% of admissions arrived at the emergency department within 3 hours of onset. Treatment with recombinant tissue plasminogen activator (rtPA) was administered to between 3.0% (Ga) and 8.5% (Mass) of ischemic stroke admissions. Of 118 subjects treated with intravenous rtPA, <20% received it within 60 minutes of arrival. Compliance with secondary prevention practices was poorest for smoking cessation counseling and best for antithrombotics. Conclusions— A minority of acute stroke patients are treated according to established guidelines. Quality improvement interventions, targeted primarily at the health care systems level, are needed to improve acute stroke care in the United States.