Background: Despite advances in endovascular stroke therapy, the use of IV TPA remains the most prevalent acute therapy for ischemic stroke. The earlier that IV thrombolytic therapy is initiated, the better the patient outcome. We analyzed data from different types of hospital stroke centers to determine if differences the rates of IV TPA administration exist. Our hypothesis was that IV TPA would be administered more consistently at Comprehensive Stroke Centers (CSCs) than Primary Stroke Centers (PSCs) and non-center certified facilities (NC).
Methods: We examined data submitted to the Joint Commission for STK-4 (acute ischemic stroke, arrival within 2 hours and IV TPA administered within 3 hours) from Q4 2013 through Q3 2014. Measure rates were analyzed for the three certification groups (CSC, PSC and NC) to see if there were any significant differences in performance using logistic mixed effects models. Drip and ship patients were excluded from the analysis.
Results: We had patient-level data from 54 CSCs, 989 PSCs, and 334 NC facilities. The average annual number of ischemic stroke admissions at each were: 367 for CSCs, 169 for PSCs, and 73 for NCs. The average annual number of patients treated with IV TPA was 23.6 at CSCs, 14.9 at PSCs, and 6.2 at NCs. The rates of IV TPA administration to eligible patients was 91% at CSCs, 85% at PSCs, and 52% at NCs. CSCs had statistically significantly higher rates of IV TPA administration compared to PSCs (p < 0.001), and PSCs had higher rates compared to NCs (p < 0.001). We did not collect data about IV TPA use out to 4.5 hours after stroke onset.
Conclusions: Patients admitted to a certified stroke center are more likely to receive IV TPA than at non-certified facilities. CSCs administer IV TPA to a higher percentage of patients than either PSCs or NC facilities. While not every hospital can become a CSC, perhaps educational efforts and care paradigms at CSCs can be emulated at other facilities to increase the use of IV TPA in appropriate patients.