Introduction: Most patients with stroke in Iowa are initially seen in small community hospitals and are subsequently transferred to another institution with a higher level of care. The Iowa Stroke Registry (ISR) was developed to assess the system of stroke care in the state. Community hospitals in the state are supported by the comprehensive stroke center (CSC) through consultation for acute stroke treatment. The objective for this project was to analyze the geographical dispersion of transfers to the CSC to begin an evaluation of the system of stroke care in the state.
Method: We analyzed the prospectively collected data in the Iowa Stroke Registry (ISR). The ISR has collected data from 32 hospitals: comprehensive (1), primary (15), and stroke capable hospitals in Iowa beginning in 2010. To date over 23, 000 patients have been enrolled. Information from this analysis included the CSC data only collected in a national database and imported ino the ISR from 2015-April, 2017 that included zip code data. During that time period 2576 patients were direct admissions or transfers to the CSC. Distances were based on the number of miles between the patients’ and CSC zip code.
Results: Approximately 80% of all stroke patients at the CSC were transferred from a community hospital. Patients originated in 78 of the 99 counties in Iowa. The median distance was 63 miles. Of the transfers from local hospitals, 86% were within 90 miles with the largest group 60-89 miles from the CSC. Of all patients transferred for ischemic stroke approximately 30% received treatment with intravenous alteplase at the outside hospital.
Conclusion: In conclusion, these data suggest a high degree of geographical dispersion for stroke patients transferred to a CSC in a rural state. This analysis of the system of stroke care in Iowa indicates the CSC provided support to multiple community hospitals for acute stroke treatment. Further analysis of the system of stroke care is needed to better understand patient transfers including mode of transfer and reason for transfer.