Door to Intravenous Tissue Plasminogen Activator Time and Hospital Length of Stay in Acute Ischemic Stroke Patients, Georgia, 2007-2013.

BACKGROUND: Ischemic stroke patients benefit most from intravenous thrombolysis when they receive the treatment as quickly as possible after symptom onset. Hospitals participating in the Georgia Coverdell Acute Stroke Registry reduced the time from patient arrival to administration of intravenous tissue plasminogen activator. This study evaluates the benefit of reducing door-to-treatment (DTT) time as measured by hospital length of stay (LOS). METHODS: Data from 3154 ischemic stroke patients treated with intravenous thrombolysis from 2007 to 2013 were analyzed. The impact of door-to-treatment time on patients' length of hospital stay, discharge disposition, ambulatory status at discharge, and bleeding complications was assessed, controlling for patient-, hospital- and event-related characteristics. RESULTS: Patients who received intravenous thrombolysis within 30 minutes of hospital arrival had a 19% shorter (95% confidence interval [CI]: 2%-32%, P value = .04) hospital LOS than those treated for more than 120 minutes after arrival. Patients treated within 60 minutes of arrival were 27% more likely (odds ratio = 1.28, 95% CI: 1.06-1.56, P = .01) to have a better discharge disposition than patients treated after 60 minutes of arrival while having a similar rate of bleeding complications. CONCLUSIONS: Shortening the door-to-treatment time is associated with a decrease in patient LOS and better patient outcomes. Hospitals should be encouraged to measure, monitor, and reduce DTT time progressively for a better patient outcome.

Hypoalbuminemia predicts acute stroke mortality: Paul Coverdell Georgia Stroke Registry.

BACKGROUND: Mortality remains unacceptably high among patients hospitalized for acute stroke. Additional knowledge about factors that contribute to mortality after stroke is important for instituting therapies to lower mortality. We sought to determine the factors that predict mortality in patients hospitalized for acute stroke. METHODS: In all, 1477 consecutively admitted patients with acute stroke in 34 hospitals in the state of Georgia participating in the Paul Coverdell Georgia Stroke Registry during a 3-month period (December 1, 2001-February 28, 2002) were identified by retrospective chart review using primary or secondary International Classification of Diseases, Ninth Revision codes. Of patients, 31% were black, 65% were white, and 58% were women. We determined inhospital mortality after admission for acute stroke in this representative group of patients. RESULTS: There were 154 (10%) inhospital deaths among the 1477 patients admitted with acute stroke. Univariate analysis showed that mortality was associated with older age (P = .0008), stroke type (P = .0051), Glasgow Coma Scale score less than 9 (P < .0001), decreased serum albumin (P = .0001), elevated creatinine (P = .0067), and elevated blood glucose (P = .0063). In the multivariate analysis, independent risk factors for mortality after acute stroke included older age (P = .004), stroke type (P = .0007), Glasgow Coma Scale score less than 9 (P < .0001), and decreased serum albumin (P = .0003). There was no relationship between race and inhospital mortality (P = .9041). In addition, there was no association between independent predictors and race. CONCLUSION: In addition to previously recognized predictors of inhospital mortality, we found hypoalbuminemia to be an independent predictor of mortality in a biracial cohort of patients with acute stroke.

Clinical characteristics of patients with early hospital arrival after stroke symptom onset.

BACKGROUND: Identifying characteristics of early arrivers after stroke may be useful to improve delivery of acute stroke treatment. We sought to identify the clinical characteristics and outcomes of patients with ischemic stroke who present early after symptom onset using data collected from a representative sample of hospitals in the state of Georgia. METHODS: Data were obtained retrospectively from a statewide observational stroke registry from December 1, 2001, to February 28, 2002, and from February 1 to March 31, 2003. Clinical characteristics of patients with stroke arriving to the hospital within 2 hours were compared with those arriving later. RESULTS: Of the 409 patients with ischemic stroke identified with a specified time of onset, 172 (42%) presented within 2 hours. Univariate analysis showed hospital arrival within 2 hours was associated with history of coronary artery disease (P = .0400), dyslipidemia (P = .0100), ambulance transport (P = .0285), stroke team consultation (P = .0070), higher National Institutes of Health Stroke Scale score (P < .0001), and lower Glasgow Coma Scale score (P = .0018). Race, sex, age, smoking history, previous stroke, myocardial infarction, congestive heart failure, prosthetic heart valve, hypertension, diabetes, and family history of stroke were not associated with arrival within 2 hours. Multivariate analysis revealed National Institutes of Health Stroke Scale score (odds ratio = 1.20, confidence interval 1.08-1.34, P = .0013) and Glasgow Coma Scale score (odds ratio = 0.84, confidence interval 0.75-0.94, P = .0027) were associated with arrival within 2 hours. Patients with stroke arriving within 2 hours had higher in-hospital mortality (13% v 4%) (P = .0284), but a higher rate of independent ambulation at discharge (55% v 37%) (P = .0419). CONCLUSIONS: Early arrival after ischemic stroke symptom onset is associated with increased stroke severity, higher mortality, and better functional outcome.