Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

What fucking stupidity. You don't measure 'care, you measure results; like 100% recovery. When will we get survivors in charge and actually solve stroke rather than tip toeing around the edges?

Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

Kristina Shkirkova^1*, Theodore T. Wang², Lily Vartanyan², David S. Liebeskind³, Marc Eckstein⁴, Sidney Starkman³, Samuel Stratton⁵, Franklin D. Pratt⁶, Scott Hamilton⁷, May Kim-Tenser², Robin Conwit⁸, Jeffrey L. Saver³ and Nerses Sanossian² on behalf of FAST-MAG Investigators and Coordinators

• ¹Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
• ²Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
• ³Department of Neurology, UCLA Comprehensive Stroke Center, Los Angeles, CA, United States
• ⁴Department of Emergency Medicine, University of Southern California, Los Angeles, CA, United States
• ⁵Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, United States
• ⁶Los Angeles County Department of Public Health, Los Angeles, CA, United States
• ⁷Department of Neurology, Stanford Stroke Center, School of Medicine, Stanford University, Palo Alto, CA, United States
• ⁸National Institutes of Health, Bethesda, MD, United States

Background and Purpose: 

Primary stroke center (PSC) certification is associated with improvements in stroke care and outcome. However, these improvements may reflect a higher baseline level of care delivery in hospitals eventually achieving certification. This study examines whether advancements in acute stroke care at PSCs are due to certification or factors intrinsic to the hospital.

Methods: 

Data was obtained from the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) trial with participation of 40 Emergency Medical System agencies, 315 ambulances, and 60 acute receiving hospitals in Los Angeles and Orange Counties. Subjects were transported to one of three types of destinations: PSC certified hospitals (PSCs), hospitals that were not PSCs at time of enrollment but would later become certified (pre-PSCs), and hospitals that would never be certified (non-PSCs). Metrics of acute stroke care quality included time arrival to imaging, use of intravenous tPA, and arrival to treatment.

Results: 

Of 1,700 cases, 856(50%) were at certified PSCs, 529(31%) were at pre-PSCs, and 315 (19%) were at non-PSCs. Mean (SD) was 33min (±76.1) at PSCs, 47(±86.6) at pre-PSCs, and 49(±71.7) at non-PSCs. Of 1,223 cerebral ischemia cases, rate of tPA utilization was 43% at PSCs, 27% at pre-PSCs, and 28% at non-PSCs. Mean ED arrival to thrombolysis was 71(±32.7) at PSC, 98(±37.6) at pre-PSC, and 95(±45.0) at non-PSCs. PSCs had improved time to imaging (p = 0.014), percent tPA use (p < 0.001), and time to treatment (p = 0.003).

Conclusions: 

Stroke care at hospitals prior to PSC certification is equivalent to care at non-PSCs.

Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT00059332.