Abstract WP87: Statewide Availability Of Acute Stroke Treatment And Services In North Carolina Hospitals

Abstract

Introduction: With recent advancements in acute stroke treatments, evidence-based care capabilities among hospitals are believed to vary widely; however, current data are limited. Therefore, we conducted a statewide assessment of hospital-based stroke care capabilities in North Carolina (NC). Methods: An online survey was emailed to each licensed hospital in NC. Based on prior surveys and current stroke care guidelines, questions asked about diagnostic testing, acute stroke treatments and protocols, and post-acute management. All 112 hospitals responded (100% response rate) between October 2020 and April 2021. Descriptive statistics were computed from responses for 109 hospitals that reported providing acute stroke care. Results: Among 109 hospitals, 10 (9%) were Comprehensive Stroke Centers, 2 (2%) were Thrombectomy-Capable Stroke Centers, 35 (32%) were Primary Stroke Centers, 16 (15%) were Acute Stroke Ready Hospitals, and 46 (42%) had no stroke certification. Ninety-eight (90%) had an acute stroke clinical care pathway, and 92 (84%) had pre-written stroke care orders. All 109 (100%) reported non-contrast CT imaging capability. Further, hospitals reported the following: CT angiography (104, 95%), CT perfusion (55, 50%), and diffusion-weighted MRI (63, 58%) . Almost all (108, 99%) administered intravenous alteplase for stroke, whereas only 16 (15%) had capabilities to provide endovascular thrombectomy for stroke. Ninety-five (87%) hospitals reported transferring stroke patients treated with alteplase or transferring those in need of endovascular treatment. Eighty-nine (82%) used telestroke services for the treatment and management of acute stroke patients, of which 78 (72%) relied on telestroke exclusively 24/7; and 80 (73%) used telestroke to decide when and where to transfer stroke patients. Conclusions: Among NC hospitals, basic capabilities, such as CT imaging and acute stroke care protocols, were widely available. However, advanced imaging and endovascular capabilities were less common. Most hospitals used telestroke services for treatment as well as transfer decisions. This statewide assessment is an important first step in improving access to evidence-based stroke care and developing stroke systems of care.