Acute stroke care in the US - Results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry

Background and Purpose - The Paul Coverdell National Acute Stroke Registry is being developed to improve the quality of acute stroke care. This article describes key features of acute stroke care from 4 prototype registries in Georgia (Ga), Massachusetts ( Mass), Michigan (Mich), and Ohio. Methods - Each prototype developed its own sampling scheme to obtain a representative sample of hospitals. Acute stroke admissions were identified using prospective ( Mass, Mich) or retrospective ( Ga, Ohio) methods. All prototypes used a common set of case definitions and data elements. Weighted site-specific frequencies were generated for each outcome. Results - A total of 6867 admissions from 98 hospitals were included; the majority were ischemic strokes ( range, 52% to 70%) with transient ischemic attack and intracerebral hemorrhage comprising the bulk of the remainder. Between 19% and 26% of admissions were younger than age 60 years, and between 52% and 58% were female. Black subjects varied from 7.1% ( Mich) to 30.6% ( Ga). Between 20% and 25% of admissions arrived at the emergency department within 3 hours of onset. Treatment with recombinant tissue plasminogen activator (rtPA) was administered to between 3.0% ( Ga) and 8.5% ( Mass) of ischemic stroke admissions. Of 118 subjects treated with intravenous rtPA, < 20% received it within 60 minutes of arrival. Compliance with secondary prevention practices was poorest for smoking cessation counseling and best for antithrombotics. Conclusions - A minority of acute stroke patients are treated according to established guidelines. Quality improvement interventions, targeted primarily at the health care systems level, are needed to improve acute stroke care in the United States.