Not all hospitals that treat acute stroke have facilities or personnel continually prepared for stroke evaluation and treatment, according to a survey to be presented by Wayne State University School of Medicine physicians at an upcoming meeting of the American Stroke Association.
As part of Operation Stroke, a stroke-awareness initiative kicked off in Detroit by the American Heart Association, hospitals and EMS providers were surveyed in Wayne, Oakland and Macomb counties. Although protocols for handling stroke patients existed in 95 percent of the hospitals that responded, only 52 percent had stroke teams and 32 percent had stroke units.
“Hospitals in the Detroit metro area currently are not operating at optimum efficiency as far as acute stroke treatment,” said Bradley Jacobs, MD, assistant professor of neurology and lead author of the study. “There are several areas we can fix to make it better.”
Of 4,049 patients treated in 1998, 61, or 4 percent, were given a drug called a tissue plasminogen activator (tPA) that eliminates or significantly reduces disability if it is administered within three hours of the stroke. Although use of tPA in Detroit is at least twice as frequent as the national average of 1.5 percent, only two-thirds of area hospitals use tPA.
“We’re better than the national average, but there are still a lot of people out there who aren’t getting it in time,” said Steven Levine, MD, professor of neurology and co-chair of Operation Stroke.
Further, only 79 percent of EMS have written protocols for stroke and 85 percent treat stroke as a time-dependent emergency.
With more than 1,000 medical students, WSU is among the nation’s largest medical schools. The school is a leader in patient care and medical research in a number of areas including cancer, women’s and children’s health and the neurosciences.
Operation Stroke Survey Results
EMS Survey
(30 percent of surveys returned)
• 79 percent have written protocols for stroke
• 85 percent are trained to treat stroke as a time-dependent medical emergency
• 91 percent treat stroke as a top priority emergency
• 61 percent are willing to transport stroke patients to the most appropriate facility
Hospital Survey
(52 percent of surveys returned)
• 90 percent have a cat scan and technician available 24 hours a day
• 84 percent have a neurologist and neurosurgeon on call
• 52 percent have a stroke team
• 32 percent have a stroke unit
• 95 percent have stroke protocols
• 68 percent use tPA when appropriate