Stroke Patients Not Getting Timely Care

Stroke patients receive brain imaging within recommended time

(RxWiki News) A key to preserving brain function and reducing disability following a stroke is receiving care quickly, however, patients are not receiving timely brain imaging, an important factor in determining the type of stroke and treatment options.

A recent study found that only 42 percent of stroke patients received brain imaging within the recommended 25 minutes of arriving at a hospital.

"Call 9-1-1 immediately if you experience stroke symptoms."

Adam Kelly, MD, lead author of the study and a neurologist at the University of Rochester Medical Center, said researchers were struck by the fact that so many patients with acute stroke symptoms did not receive a brain scan within the recommended amount of time.

He noted that the study looked at hospitals actively participating in a national quality improvement program so rates in hospitals that aren't participating in the program could be even worse.

Brain imaging aids in the stroke diagnosis process and allows doctors to decide on treatment options. Ischemic stroke patients may be eligible to receive clot-busting drug tissue plasminogen activator (tPA) to restore blood flow and improve functional outcome, but it is most effective within three hours of the onset of stroke symptoms so timing can be key.

During the study investigators used data collected through the American Heart Association's Get with the Guidelines program, designed to improve the quality of stroke care. There were 1,199 hospitals participating in the program at the time of the study.

Researchers analyzed imaging times for 40,777 ischemic stroke patients who were candidates for tPA, arrived at the hospital within three hours and did not have other medical conditions that would rule out the use of tPA.

In addition to low compliance with brain imaging guidelines, investigators found that stroke patients were 47 percent less likely to receive timely brain scans if they did not arrive at the hospital by ambulance.

Stroke patients were also less likely to receive scans within the recommended guideline if they had certain known risk factors for stroke such as diabetes, peripheral vascular disease, a prior history of stroke or were over 75 years old.

Non-white patients also tended to experience delays in receiving brain scans, though certain ethnic and racial groups have a higher incidence of stroke.

Patients that were imaged faster were 63 percent more likely to receive tPA, and tended to receive it sooner as compared to 38 percent of stroke patients who received tPA, but did not receive imaging within 25 minutes.

“Despite the strides that have been made in stroke care, it is clear that there is significant room for improvement in the evaluation of patients suspected of stroke,” Dr. Kelly said.

“Time is too precious and hospitals cannot be the reason for delay.”

The research was recently published in journal Stroke.

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Review Date: 
May 2, 2012