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. 2012 Apr;43(4):1089-93.
doi: 10.1161/STROKEAHA.111.635334. Epub 2012 Jan 26.

Organization of a United States county system for comprehensive acute stroke care

Steven C Cramer  1 , Dana Stradling, David M Brown, Ignacio M Carrillo-Nunez, Anthony Ciabarra, Michael Cummings, Richard Dauben, David L Lombardi, Nirav Patel, Elizabeth N Traynor, Stephen Waldman, Ken Miller, Samuel J Stratton
Affiliations

Organization of a United States county system for comprehensive acute stroke care

Steven C Cramer et al. Stroke. 2012 Apr.

Abstract

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 <5 hours duration transported by emergency medical system personnel to an SNRC during the first year of this system.

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 <60-minute target in only 25% of patients and was 37% longer (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.

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Figures

Figure 1
Figure 1
The map shows the nine hub SNRC in Orange County, CA (population over 3 million, spanning 789 square miles) including the six with neurointerventional capability and the three without, as well as the 14 spoke hospitals.
Figure 2
Figure 2
Among the 395 EMS-transported patients with acute ischemic stroke taken to a neurointerventional-ready SNRC, the time of ER arrival was unevenly distributed (p < 0.0001).
See this image and copyright information in PMC

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