PURPOSE: Effectiveness of Primary Stroke Centers (PSC) in improving clinical outcomes has been well established. Establishing and maintaining PSC depend on existing staffing and infrastructure, and can impose an additional burden on community hospitals. We describe the successful implementation and outcomes of a PSC in an innercity hospital without the need for additional financial resources.
METHODS: A PSC was established in 2005 based on the recommendations of the Brain Attack Coalition. The center was primarily driven by the on site intensivists (24/7), and all eligible patients were treated as per standard acute stroke protocols. A prospective stroke registry was maintained including information on the number of patients with stroke, number of patients eligible and treated with thrombolytics, time intervals in obtaining CT and patient outcomes. Data “pre” and “post” PSC implementation was compared and analyzed. Data from our PSC was compared to regional and national data obtained from “Get With The Guidelines” (GWTG) stroke initiative.
RESULTS: During the 2-year period after establishing the PSC, 80 patients presented with ischemic stroke and all of the 12 eligible patients were treated with intravenous tPA. This resulted in a significantly increased use of thrombolytics compared to pre-PSC. The median door to CT done was 24 minutes and door to CT interpretation was 44 minutes. Median door to needle time was 66 minutes. Among patients who received tPA, 8/ 12(66%) showed neurological improvement. Observed mortality for all stroke patients was 5% (4/ 80). No staff was added or any additional financial expenses incurred.
CONCLUSION: Establishment of a primary stroke center at an inner city hospital resulted in a substantially short ‘door to imaging’ and ‘door to needle times’. Additionally this led to an increase in the proportion of patients receiving thrombolytic therapy for ischemic stroke. To the best of our knowledge this is the only stroke center that is directed and managed by critical care professionals.
CLINICAL IMPLICATIONS: PSC can be successfully implemented in an inner city hospital staffed 24/7 by intensivists.
DISCLOSURE: Sindhaghatta Venkatram, No Financial Disclosure Information; No Product/Research Disclosure Information