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Abstract Details

Thrombolytic Utilization in Ischemic Stroke Is Significantly Higher in US Hospitals with Neurology Residency Program
Cerebrovascular Disease and Interventional Neurology
S02 - (-)
006
Neurology residency programs may influence the frequency of tPA use among teaching hospitals.
All US NR programs listed on the Accreditation Council for Graduate Medical 好色先生 website and the affiliated hospitals from individual program website were screened and cross-matched to hospitals sampled in Nationwide Inpatient Sample (NIS) for years 2000-2010. States suppressing hospital identification in NIS (38% of all) were excluded due to inability to ascertain NR hospitals. Ischemic stroke cases and tPA use were identified by ICD-9 codes. We conducted complex sample analysis using discharge weights to calculate population estimates.
6,064 hospital samples with 671,549 unweighted ischemic stroke cases were included: 10.7%, 30.3% and 60.0% were treated at NR, TH, and NT respectively. Overall tPA rate was 2.1 卤 0.1(SE)% over the 11 year study period. The tPA rate at NR (3.8 卤 0.3%) was higher compared to TH (2.4 卤 0.1%, p<0.001) and NT (1.6 卤 0.1%, p<0.001). Rate of tPA utilization in NR increased approximately 4-fold between 2002 (1.2%) and 2006 (4.9%). During the same period, TH (0.9% to 2.3%) and NT (0.7% to 1.5%) had slower increase in tPA use. Factors associated with higher tPA use in NR were male gender, Caucasian race, lower comorbidity score, and higher stroke case volume. In multivariate analysis, NR was independently predictive of higher tPA rate [(OR:1.49; 95% CI:1.42-1.57 (NR vs. TH), OR:1.66; 95% CI 1.57-1.76 (NR vs. NT)].
Stroke care at NR hospitals is associated with an increased thrombolytic utilization rate. The increased tPA utilization at NR between 2002-2006 may be related to the rapid increase in Primary Stroke Centers across the country.
Authors/Disclosures
Yogesh Moradiya, MD
PRESENTER 		No disclosure on file
Jihan A. Grant, MD (Mt Sinai) No disclosure on file
Helen A. Valsamis, MD (NYCHH - Kings County Hospital) No disclosure on file
Steven Levine, MD, FAHA (SUNY Downstate Medical Center) Dr. Levine has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MEDLINK. Dr. Levine has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Law Firms. The institution of Dr. Levine has received research support from NIH.
Michael D. Geschwind, MD, PhD, FAAN (UCSF) Dr. Geschwind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Brainstorm Cell Therapeutics, Inc.. Dr. Geschwind has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Walter Grubb. Dr. Geschwind has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gerson Lehrman Group. Dr. Geschwind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Reata Pharmaceuticals, Inc..