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Geographic Differences in Acute Stroke Care in Catalunya: Impact of a Regional Interhospital Network

2008; Karger Publishers; Volume: 26; Issue: 3 Linguagem: Inglês

10.1159/000147457

1421-9786

Marc Ribó, Carlos A. Molina, Àngels Pedragosa, Carme Sanclemente, Estevo Santamarina, Marta Rubiera, Raquel Delgado‐Mederos, Olga Maisterra, Manuel Quintana, José Álvarez‐Sabín,

Stroke Rehabilitation and Recovery

Limited resources prevent specialized care in community hospitals (CH) challenging geographical equity. We studied the impact of a regional interhospital network based on urgent transfer from 4 CH to a referral stroke center (RSC). <i>Methods:</i> During 2006, all stroke patients admitted to the 5 networked hospitals (4 CH, 1 RSC) were studied: clinical pathways and stroke interventions were recorded. Physicians at CH decided emergent transfer under their clinical judgment. Quality therapeutic measures where defined: urgent expert neurological evaluation, stroke unit admission and thrombolytic treatment. For patients receiving tissue plasminogen activator, demographic and outcome data were recorded: clinical improvement (decrease ≧4 National Institute of Health Stroke Scale points at discharge), total recovery (3-month modified Rankin Scale score ≧1). <i>Results:</i> From a total of 1,925 acute stroke patients, 1,587 were admitted to the RSC (1,396 primarily). Of 529 primarily admitted to CH, 191 (36.1%) were emergently transferred. Patients primarily admitted to the RSC were more frequently evaluated by a neurologist (100 vs. 34%; p < 0.001) and admitted to a stroke unit (22.7 vs. 11.7%; p < 0.001). However, the rate of thrombolytic treatment was similar (4.4 vs. 5.1%; p = 0.491). After initial assessment at the RSC, 92 (48.2%) transfers were considered unnecessary. Transferred patients accounted for 27/88 (30.7%) thrombolyses performed in the RSC. Baseline characteristics were similar, except a longer time to treatment (164 vs. 211 min; p = 0.004) and more frequent early ischemia CT signs among transferred patients (23 vs. 53%; p = 0.037). Clinical improvement (62 vs. 50%; p = 0.273) and symptomatic hemorrhagic transformation (6.8 vs. 3.8%; p = 0.596) were similar. However, among transferred patients, the degree of total recovery was lower (44 vs. 22%; p = 0.05). <i>Conclusion:</i> An interhospital network based on transfers to an RSC does not warrant geographical equity: equal access to best therapeutic interventions is only partially achieved at the expense of a high proportion of unnecessary transfers.