Abstract
Background: The evolution of acute ischemic stroke (AIS) treatment networks has yielded many so-called spoke and hub networks, where patients may present to hospitals that possess stroke expertise, but perhaps not the full range of treatment options such as those present at so-called hubs. Presentation patterns at spokes and hubs may differ in terms of demographics, severity, and in terms of presentation time, which may yield opportunities to target specific AIS therapy subgroups. Hypothesis: We hypothesized that patients present earlier to stroke ready regional community hospitals than the centrally located main campus and therefore provide greater potential opportunity for acute stroke intervention. Methods: The Cleveland Clinic Health System Stroke network is comprised of a quaternary main campus and 10 regional hospitals. There are two regional hospital tertiary stroke treatment hubs, located geographically east and west of the main campus. AIS time data were reviewed at each of these three centers, not including the other [n] primary stroke centers in the system spanning 2008 through the first half of 2011. Time from last known well to hospital presentation was calculated for each patient, patients with missing time data were excluded, yielding a total of 2269 consecutive patients. Presentation times were then graphed, and patterns analyzed. Conclusions: The time data queried suggests that AIS patients arrive earlier in their course at the two regional centers by a large margin. Therefore, a higher percentage of total presenting patients may be eligible for acute stroke intervention and trials. The pattern of presentation times may or may not be unusual to that of the Cleveland Clinic system, but such variation in patient presentation patterns may suggest more efficient avenues of trial recruitment. Clinical research integrated throughout a stroke hospital system would likely yield better quality and quantity patient recruitment.
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