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From the Departments of Epidemiology (Y.Z.D., M.J.R., A.J.M.) and Neurology and Ophthalmology (G.L.B., S.W., A.M.), Michigan State University, East Lansing; Department of Neurology (B.S.J.), Wayne State University, Detroit; Borgess Medical Center (R.U.K.), Kalamazoo; and Department of Neurology (S.L.H., K.M.), University of Michigan, Ann Arbor.
Address correspondence and reprint requests to Dr. Mathew J. Reeves, Department of Epidemiology, B 601 West Fee Hall, Michigan State University, East Lansing, MI 48824; e-mail: reevesm{at}msu.edu
Objective: To assess the use of IV recombinant tissue plasminogen activator (rt-PA) in a statewide hospital-based stroke registry and to identify factors associated with its use among eligible patients.
Methods: A modified stratified sampling scheme was used to obtain a representative sample of 16 hospitals. Prospective case ascertainment and data collection were used to identify all acute stroke admissions over a 6-month period. Subjects eligible for IV rt-PA were defined as those who arrived within 3 hours of onset, who had no evidence of hemorrhage on initial brain image, and who had no physician-documented reasons for non-treatment with IV rt-PA. Multivariate logistic regression was used to identify factors associated with IV rt-PA use.
Results: Of 2,566 stroke admissions, 330 (12.9%) met the eligibility criteria for rt-PA treatment, and of these 43 (13%) received IV rt-PA treatment. Among 2,236 admissions excluded from consideration, 21% had evidence of hemorrhage on initial imaging, 35% had unknown stroke onset times, 38% had an onset to arrival time >3 hours, and 6% had physician documented contraindications. Among eligible patients, being male, use of emergency medical services, and rapid presentation were associated with increased IV rt-PA use.
Conclusions: Treatment with IV rt-PA was underutilized in this hospital-based stroke registry. The primary reason for nontreatment was delayed presentation. Reducing prehospital and in-hospital response times would help increase IV rt-PA use, as would greater emergency medical services use. Improving the documentation of onset times would help clarify the underlying causes of delayed presentation.
Commentary, see page 297
Supported by US Centers for Disease Control and Prevention Collaborative Agreement No. U50/CCU520272-01.
Disclosure: The authors report no conflicts of interest.
Received June 16, 2005. Accepted in final form October 3, 2005.
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