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Influence of the stroke code activation source on the outcome of acute ischemic stroke patients

From the Stroke Unit (N.P.d.l.O., M.M., J.F.A., A.D.), Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona; Department of Neurology (J.S.-O.), Hospital Esperit Sant, Santa Coloma de Gramanet; Department of Neurology (E.P.), Hospital General Mataró; Department of Neurology (L.D.), Hospital Municipal Badalona; Department of Neurology (C.G.), Hospital Sant Jaume de Calella; Catalan Agency for Health Technology Assessment and Research (CAHTA) (S.A.), Barcelona, Spain.

Address correspondence and reprint requests to Dra. Natalia Pérez de la Ossa Herrero, Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Carretera del Canyet s.n. 08916, Badalona, Spain 35783npo{at}comb.es

Introduction: In our metropolitan area, the Stroke Code (SC) system allows immediate transfer of patients with acute stroke to a stroke center. It may be activated by community hospitals (A), emergency medical services (EMS, B), or the emergency department of the stroke center (C). Our aim was to analyze whether the SC activation source influences the access to thrombolytic therapy and outcome of patients with ischemic stroke.

Methods: We prospectively registered patients with ischemic stroke admitted to the acute stroke unit who arrived through the SC system. The primary outcome variable was good outcome at discharge (Rankin Scale 2). Secondary outcome was neurologic improvement 4 in National Institutes of Health Stroke Scale (NIHSS) score or NIHSS score 0 to 1 at 24 hours.

Results: A total of 262 consecutive patients with hyperacute ischemic stroke were studied; the SC source was A in 112, B in 57, and C in 92. Median time from onset to admission was longer in Group A and stroke severity higher in Groups B and C. Percentage of tPA administration was higher in patients from Groups B and C (27%, 54%, and 46% of patients; p = 0.001). With respect to Group A, Group B was associated with good outcome with an odds of 2.9 (1.2–6.6; p = 0.01), and Group C with an odds of 2.4 (1.1–4.9; p = 0.01) after adjustment for age and stroke severity at baseline. Patients coming via levels B and C were more likely to improve at 24 hours.

Conclusions: Patients arriving directly to the stroke center via emergency medical services or on their own receive neurologic attention sooner, are more frequently treated with tPA, and have better clinical outcome than those patients who are first taken to a community hospital.

Abbreviations: EMS = emergency medical services; mRS = modified Rankin Score; NIHSS = National Institutes of Health Stroke Scale; SC = Stroke Code.

Editorial, page 1232

e-Pub ahead of print on March 5, 2008, at www.neurology.org.

Disclosure: The authors report no conflicts of interest.

Received June 5, 2007. Accepted in final form September 10, 2007.

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				D. S. Whitcomb and N. Perez de la Ossa INFLUENCE OF THE STROKE CODE ACTIVATION SOURCE ON THE OUTCOME OF ACUTE ISCHEMIC STROKE PATIENTS Neurology, May 12, 2009; 72(19): 1709 - 1710. [Full Text] [PDF]

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