Influence of the stroke code activation source on the outcome of acute ischemic stroke patients

Neurology. 2008 Apr 8;70(15):1238-43. doi: 10.1212/01.wnl.0000291008.63002.a5. Epub 2008 Mar 5.


Introduction: In our metropolitan area, the Stroke Code (SC) system allows immediate transfer of patients with acute stroke to a stroke center. It may be activated by community hospitals (A), emergency medical services (EMS, B), or the emergency department of the stroke center (C). Our aim was to analyze whether the SC activation source influences the access to thrombolytic therapy and outcome of patients with ischemic stroke.

Methods: We prospectively registered patients with ischemic stroke admitted to the acute stroke unit who arrived through the SC system. The primary outcome variable was good outcome at discharge (Rankin Scale <or= 2). Secondary outcome was neurologic improvement >or=4 in National Institutes of Health Stroke Scale (NIHSS) score or NIHSS score 0 to 1 at 24 hours.

Results: A total of 262 consecutive patients with hyperacute ischemic stroke were studied; the SC source was A in 112, B in 57, and C in 92. Median time from onset to admission was longer in Group A and stroke severity higher in Groups B and C. Percentage of tPA administration was higher in patients from Groups B and C (27%, 54%, and 46% of patients; p = 0.001). With respect to Group A, Group B was associated with good outcome with an odds of 2.9 (1.2-6.6; p = 0.01), and Group C with an odds of 2.4 (1.1-4.9; p = 0.01) after adjustment for age and stroke severity at baseline. Patients coming via levels B and C were more likely to improve at 24 hours.

Conclusions: Patients arriving directly to the stroke center via emergency medical services or on their own receive neurologic attention sooner, are more frequently treated with tPA, and have better clinical outcome than those patients who are first taken to a community hospital.

MeSH terms

  • Academic Medical Centers / standards
  • Academic Medical Centers / statistics & numerical data
  • Academic Medical Centers / trends
  • Acute Disease / nursing
  • Acute Disease / therapy
  • Aged
  • Brain Ischemia / diagnosis
  • Brain Ischemia / drug therapy
  • Brain Ischemia / nursing
  • Diagnosis-Related Groups
  • Early Diagnosis
  • Emergency Medical Service Communication Systems / standards*
  • Emergency Medical Service Communication Systems / statistics & numerical data
  • Emergency Medical Service Communication Systems / trends
  • Emergency Medical Services / standards*
  • Emergency Medical Services / statistics & numerical data
  • Emergency Medical Services / trends
  • Emergency Service, Hospital / standards*
  • Emergency Service, Hospital / statistics & numerical data
  • Emergency Service, Hospital / trends
  • Female
  • Hospitals, Community / statistics & numerical data
  • Humans
  • Intensive Care Units / standards
  • Intensive Care Units / statistics & numerical data
  • Intensive Care Units / trends
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Patient Transfer / standards
  • Patient Transfer / statistics & numerical data
  • Patient Transfer / trends
  • Prospective Studies
  • Spain
  • Stroke / diagnosis
  • Stroke / drug therapy*
  • Stroke / nursing*
  • Thrombolytic Therapy / standards
  • Thrombolytic Therapy / statistics & numerical data
  • Thrombolytic Therapy / trends
  • Time Factors
  • Transportation of Patients / standards
  • Transportation of Patients / statistics & numerical data
  • Transportation of Patients / trends