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| Stroke thrombolysis safe at community hospitals |
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08 February 2006
In treating patients with acute ischaemic stoke, community hospitals use thrombolytic therapy as safely as do academic medical centres, researchers report in the February issue of Stroke.
Dr Schumacher and colleagues from the Columbia Presbyterian Medical College for Physicians and Surgeons, Columbia University, New York, USA therefore examined outcomes in acute stroke patients treated with thrombolysis using the largest discharge database available in the United States for the years 1999 to 2002. Data were derived from the Nationwide Inpatient Sample for the years 1999 to 2002. Using the appropriate International Classification of Disease-Clinical Modification, 9th revision, codes, patients admitted through the emergency room with a primary diagnosis of acute ischaemic stroke were selected for analysis. From these patients, those coded as receiving thrombolysis were identified. Multivariate logistic regression was performed on the thrombolysis and non-thrombolysis cohorts to identify independent predictors of in-hospital mortality from among those clinical elements available in the database.
The group identified 2594 patients treated with thrombolysis from a group of 248,964 patients admitted through the emergency room with a primary diagnosis of acute ischaemic stroke. The thrombolysis cohort had a higher in-hospital mortality rate compared with the non-thrombolysis patients (11.4% versus 6.8%). The rate of intracerebral haemorrhage was 4.4% for the thrombolysis cohort and 0.4% for non-thrombolysis patients. Multivariate logistic regression showed advanced age, Asian/Pacific Islander race, congestive heart failure, and atrial fibrillation/flutter to be independent predictors of in-hospital mortality after thrombolysis. Thrombolysis volume, overall ischaemic stroke volume, and teaching status were not significant predictors of in-hospital mortality after thrombolysis.
"Those findings are also in the range of those obtained in previous prospective trials," said Dr Schumacher, and relative to academic centres, "show that thrombolysis is applied in the community with the same safety." Nevertheless, he concluded that "the results can only be preliminary since we had to use a discharge database. A prospective stroke registry that will be similar to the National Cancer Registry is currently in the pilot phase so, in the future, we will have better data to work from."
Reference:
Stroke 2006; 37 (2): 440-446.
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