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Prehospital factors determining regional variation in thrombolytic therapy in acute ischemic stroke

Lahr, M. M. H., Vroomen, P. C. A. J., Luijckx, G-J., van der Zee, D-J., de Vos, R. & Buskens, E., Oct-2014, In : International Journal of Stroke. 9, SA100, p. 31-35 5 p.

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  • Prehospital factors determining regional variation in thrombolytic therapy in acute

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Background Treatment rates with intravenous tissue plasminogen activator vary by region, which can be partially explained by organizational models of stroke care. A recent study demonstrated that prehospital factors determine a higher thrombolysis rate in a centralized vs. decentralized model in the north of the Netherlands.

Aim To investigate prehospital factors that may explain variation in thrombolytic therapy between a centralized and a decentralized model.

Methods A consecutive case observational study was conducted in the north of the Netherlands comparing patients arriving within 4.5 h in a centralized vs. decentralized stroke care model. Factors investigated were transportation mode, prehospital diagnostic accuracy, and preferential referral of thrombolysis candidates. Potential confounders were adjusted using logistic regression analysis.

Results A total of 172 and 299 arriving within 4.5 h were enrolled in centralized and decentralized settings, respectively. The rate of transportation by emergency medical services was greater in the centralized model (adjusted odds ratio 3.11; 95% confidence interval, 1.59-6.06). Also, more misdiagnoses of stroke occurred in the central model (P = 0.05). In postal code areas with and without potential preferential referral of thrombolysis candidates due to overlapping catchment areas, the odds of hospital arrival within 4.5 h in the central vs. decentral model were 2.15 (95% confidence interval, 1.39-3.32) and 1.44 (95% confidence interval, 1.04-2.00), respectively.

Conclusions These results suggest that the larger proportion of patients arriving within 4.5 h in the centralized model might be related to a lower threshold to use emergency services to transport stroke patients and partly to preferential referral of thrombolysis candidates.

Original languageEnglish
Pages (from-to)31-35
Number of pages5
JournalInternational Journal of Stroke
Volume9
Issue numberSA100
Publication statusPublished - Oct-2014

    Keywords

  • acute stroke, organizational model, prehospital, regional variation, thrombolysis, TISSUE-PLASMINOGEN ACTIVATOR, INTRAVENOUS THROMBOLYSIS, PRIMARY-CARE, RECOMMENDATIONS, IMPLEMENTATION, EXPERIENCE, PHYSICIANS, ALTEPLASE, SYSTEMS

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