http://www.cmajopen.ca/content/2/4/E233.full
- Aravind Ganesh, MD1,
- Marie Camden, MD2,
- Patrice Lindsay, RN, PhD3,
- Moira K. Kapral, MD4,
- Robert Coté, MD5,
- Jiming Fang, PhD6,
- Brandon Zagorski, MSc6,
- Michael Douglas Hill, MD, MSc1,
- for the Canadian Stroke Audit Group
+ Author Affiliations
- Correspondence to:
Michael D. Hill, michael.hill@ucalgary.ca
Abstract
Background The use of
thrombolysis in acute stroke is an important indicator of the quality of
stroke care, because it requires health
care providers to work collaboratively, rapidly
and accurately to optimize patient outcomes. We sought to assess the
quality
of hyperacute stroke care in Canada using the
rate of thrombolysis as the key indicator.
Methods We used
national administrative data and a chart audit in a retrospective cohort
design. We identified discharge diagnoses
of stroke in the 10 Canadian provinces between
2008 and 2009. We drew a sample (over-weighted by population and
hospital size)
for a detailed chart review that was focused on
identifying indicators of acute stroke care. We determined the
proportions
of thrombolysis use, complications and outcomes,
adjusted for age and sex and stratified by type of hospital.
Results Our final
audit sample included 9588 patient charts, representative of 88% of the
43 651 cases of stroke for which patients
were admitted to hospital in Canada. A total of
5.4% (95% confidence interval [CI] 5.1–5.6) of patients with stroke and
6.1%
(95% CI 5.8–6.4) of patients with ischemic
stroke received thrombolysis. Comprehensive stroke centres used
thrombolysis in
about one-third of ischemic cases — double the
rate seen in primary stroke centres. Often (35%–49% of the time),
thrombolysis
was not given owing to an interval of more than
4.5 hours between stroke onset and arrival at hospital.
Interpretation The use
of thrombolysis for acute stroke in Canada remains low and is limited
by delays in both the arrival of patients to
hospital and the in-hospital processes of
neuroimaging and thrombolysis administration. Our data show the critical
need for
concerted national efforts to improve education
regarding the treatment of acute stroke and speed up stroke management
in
the hospital setting.
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