Document Detail

Cuyahoga County Operation Stroke speed of emergency department evaluation and compliance with National Institutes of Neurological Disorders and Stroke time targets.
MedLine Citation:
PMID:  12624218     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Although the National Institutes of Neurological Disorders and Stroke (NINDS) has established time targets for the evaluation of acute stroke patients, little is known about how often these targets are met in the community. To track compliance with NINDS guidelines, Cuyahoga County Operation Stroke implemented a countywide data collection process that provides comparative reporting of hospital performance. METHODS: Data on the emergency department evaluation of stroke patients have been retrospectively collected since January 2000 by hospitals participating in Cuyahoga County Operation Stroke. All hospitals used a 1-page form that includes NINDS time target information. RESULTS: Median time to emergency department arrival for the 1003 patients in this cohort was 115 minutes; 382 patients (38%) arrived in <3 hours; 506 (50%) arrived in <6 hours. After arrival, median time to physician contact was 12 minutes, time to CT was 65 minutes, and time to imaging results was 105 minutes. Earlier arrival intervals after symptom onset were independently associated with shorter evaluation times. All time targets were met in patients receiving intravenous tissue plasminogen activator. CONCLUSIONS: A countywide data collection system for acute stroke evaluation is feasible. In the Cleveland metropolitan area, time to physician contact is close to the recommended NINDS target. Time to CT and time to imaging results are substantially longer than recommended. However, there was wide variation between hospitals. The association between time to arrival, speed of evaluation, and administration of intravenous tissue plasminogen activator suggests that community physicians selectively accelerate the evaluation and management of potential thrombolysis candidates.
Irene L Katzan; Thomas M Graber; Anthony J Furlan; Sophia Sundararajan; Cathy A Sila; Gary Houser; Dennis M Landis;
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-03-06
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  34     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-04     Completed Date:  2003-04-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  994-8     Citation Subset:  IM    
MetroHealth Medical Center, Cleveland Clinic Foundation, Ohio 44109-1998, USA.
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MeSH Terms
Emergency Service, Hospital / standards*
Guideline Adherence*
National Institutes of Health (U.S.)
Nervous System Diseases / therapy
Stroke / diagnosis,  drug therapy,  therapy*
Thrombolytic Therapy
Time Factors
Tissue Plasminogen Activator / administration & dosage,  therapeutic use
United States
Reg. No./Substance:
EC Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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