J Clin Outcomes Manage
Utilization and outcome of thrombolytic therapy for acute ischemic stroke: the St. John Hospital code stroke experience
Salami S, Kolluru A, Al-Najafi S, Stover C, Mar A, Szpunar S, Moudgil S
ABSTRACT: Objective: To examine the impact of an acute stroke protocol on care of acute ischemic stroke patients. Methods: A retrospective chart review was conducted of adult patients with acute ischemic stroke for the 1 year preceding and following the initiation of a code stroke team. We collected data on demographic and clinical characteristics, laboratory values, use of tPA, and in-hospital outcomes. The 2 time periods were compared using chi-square analysis, Studentís t test, and logistic regression. Results: 186 patients were included: 66 in the pre-protocol period and 120 post-protocol. Overall, 51.2% of subjects were female, 66.5% were age 41 to 80 years, 31.1% were over age 80, and 2.4% were age 40 years or younger. Patients in the pre-protocol period were more likely to have ever smoked (p = 0.007) and to have COPD/asthma (p = 0.04). The use of tPA between the 2 periods was not significantly different: 25.8% pre-protocol vs. 27.5% post-protocol (p = 0.8). Neither inpatient nor short-term outcomes differed significantly between periods. Overall, individuals who had a previous cerebrovascular accident (CVA) were less likely to get tPA (OR, 0.38 [p = 0.02]). Multivariate analysis confirmed that the only significant predictor of tPA use was previous CVA. Individuals who received tPA were more likely to die (OR, 6.6 [p < 0.001]). Conclusion: Our rate of tPA use, already above the national average, remained steady after the institution of a code stroke team. More research is required to understand physician utilization of tPA and its effect on outcomes.
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