Analysis of a Coordinated Stroke Center and Regional Stroke Network on Access to Acute Therapy and Clinical Outcomes

Background and Purpose—Compare access and outcomes in a tertiary care community hospital (Saint Luke’s Neuroscience Institute) and its stroke network to hospitals in 3 national databases. Methods—Retrospective analysis of ischemic stroke patients (2005, 2007, 2010) in Saint Luke’s (n=1576), Get With The Guidelines-Stroke (n=423 809), Premier (n=91 598), and Merci Registry (n=966). Study measures were use of computed tomography scans and tissue plasminogen activator (tPA), symptomatic intracranial hemorrhage, discharge disposition, discharge National Institutes of Health Stroke Scale scores, and 90-day modified Rankin Scores. Results—Saint Luke’s increased access to care with higher tPA use than other hospitals (17.2% received intravenous tPA therapy compared with 5.8% at Get With The Guidelines–Stroke hospitals, P<0.001; 22.1% of Saint Luke’s patients received tPA by any route compared with 3.5% of Premier patients, P<0.001). Use of intravenous tPA within 4.5 hours of onset was associated with more discha...