Triage to a Certified Stroke Center Reduces Early Mortality
By Matthew E. Fink, MD
Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital
Dr. Fink reports he is a retained consultant for Procter & Gamble and Pfizer.
SOURCE: Bekelis K, Marth NJ, Wong K, et al. Primary Stroke Center hospitalization for elderly patients with stroke. Implications for case fatality and travel times. JAMA Intern Med doi:10.1001/jamainternalmed.2016.3919.
In a national attempt to improve stroke care, there has been widespread certification of primary stroke centers (PSCs) by The Joint Commission. It has been assumed that outcomes will be better in the PSCs, but there have always been questions regarding how much additional time is acceptable to travel to a PSC, compared to a local hospital, in terms of successful treatment and outcomes. The investigators queried a Medicare database, examining the association of case fatality for patients with stroke when receiving care in a PSC vs. other hospitals, to identify the effects of prolonged travel time. This was a retrospective study of 865,184 elderly patients with stroke, with a mean age of 78.9 years, and 55.5% were female. The investigators found that 53.9% of the patients were treated in PSCs. In addition, they found that admission to a PSC was associated with a 1.8% lower seven-day mortality and a 1.8% lower 30-day case fatality. Fifty-six patients with stroke needed to be treated in a PSC to save one life at 30 days. In an analysis of the effect of additional travel time, receiving treatment in a PSC was associated with a survival benefit for patients who traveled less than 90 minutes. Traveling more than 90 minutes to reach a PSC offset any benefit of the PSC care.
In an analysis of the effect of additional travel time, receiving treatment in a primary stroke center was associated with a survival benefit for stroke patients who traveled less than 90 minutes. Traveling more than 90 minutes to reach a primary stroke center offset any benefit.
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