Abstract TP372: Stroke Patients Transported To A Primary Stroke Center More Likely To Receive Intravenous Tissue Plasminogen Activator

Abstract

Background: South Carolina (SC) is located in the “buckle” of the stroke belt with one of the highest stroke death rates in the country. In 2010, SC had 66 acute care hospitals caring for strokes, nine of which were certified primary stroke centers (PSC). The rate of intravenous tissue plasminogen activator (IV-tPA) use and its correlates have not been investigated in the state. Objectives: To study the rate of IV-tPA use and its correlates using the statewide hospital discharge records stored at SC Department of Health and Environmental Control (DHEC), for the calendar year 2010. Methods: A retrospective analysis was conducted of the statewide hospital discharge records stored at SC DHEC, for the calendar year 2010. Patients with a discharge diagnosis of ischemic stroke were included in the analysis. Variables considered included patient demographics, insurance status, location/type of destination hospital, and treatment with IV-tPA. Results: In the calendar year 2010, 10,377 hospitalized patients in SC were assigned a primary discharge diagnosis of ischemic stroke. Of these, 4.2% (442) were treated with IV-tPA. Those who were treated with IV-tPA were younger (mean age ± standard deviation=66.7 ± 14.4, p=0.002) compared with those who did not receive IV-tPA (68.8±13.6). Patients treated at a PSC (49% of all ischemic stroke patients) were more likely to receive IV-tPA (Odds Ratio or OR 4.0, 95% CI 3.2-5.0).Patients treated in hospitals located in urban counties were more likely to receive IV-tPA compared to those treated in rural counties (OR 1.3, 95% CI 1.1-5.3). On multivariate logistic regression analysis, patients treated at a PSC (Adjusted OR 2.2, 95% CI 1.9-2.5) and those treated in urban counties (Adjusted OR 1.4, 95% CI 1.1-1.8) independently increased the likelihood of receiving IV-tPA. Gender, race and insurance status did not significantly change the likelihood of receiving IV-tPA. Conclusions: Younger stroke patients, treatment in a PSC and hospitals located in an urban county increased the likelihood of receiving IV-tPA. Increasing community awareness of PSCs, their location and designation may increase the rate of IV-tPA use.