Conflict of interest: None declared.
Prehospital factors determining regional variation in thrombolytic therapy in acute ischemic stroke
Article first published online: 23 DEC 2013
© 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization
International Journal of Stroke
Special Issue: World Stroke Day Edition 2014
Volume 9, Issue Supplement A100, pages 31–35, October 2014
How to Cite
Lahr, M. M. H., Vroomen, P. C. A. J., Luijckx, G.-J., van der Zee, D.-J., de Vos, R. and Buskens, E. (2014), Prehospital factors determining regional variation in thrombolytic therapy in acute ischemic stroke. International Journal of Stroke, 9: 31–35. doi: 10.1111/ijs.12236
- Issue published online: 29 OCT 2014
- Article first published online: 23 DEC 2013
- Manuscript Accepted: 14 OCT 2013
- Manuscript Received: 30 MAY 2013
- Netherlands Organisation for Health Research and Development (ZonMw). Grant Number: 80-82800-98-104
- acute stroke;
- organizational model;
- regional variation;
Treatment rates with intravenous tissue plasminogen activator vary by region, which can be partially explained by organizational models of stroke care. A recent study demonstrated that prehospital factors determine a higher thrombolysis rate in a centralized vs. decentralized model in the north of the Netherlands.
To investigate prehospital factors that may explain variation in thrombolytic therapy between a centralized and a decentralized model.
A consecutive case observational study was conducted in the north of the Netherlands comparing patients arriving within 4·5 h in a centralized vs. decentralized stroke care model. Factors investigated were transportation mode, prehospital diagnostic accuracy, and preferential referral of thrombolysis candidates. Potential confounders were adjusted using logistic regression analysis.
A total of 172 and 299 arriving within 4·5 h were enrolled in centralized and decentralized settings, respectively. The rate of transportation by emergency medical services was greater in the centralized model (adjusted odds ratio 3·11; 95% confidence interval, 1·59–6·06). Also, more misdiagnoses of stroke occurred in the central model (P = 0·05). In postal code areas with and without potential preferential referral of thrombolysis candidates due to overlapping catchment areas, the odds of hospital arrival within 4·5 h in the central vs. decentral model were 2·15 (95% confidence interval, 1·39–3·32) and 1·44 (95% confidence interval, 1·04–2·00), respectively.
These results suggest that the larger proportion of patients arriving within 4·5 h in the centralized model might be related to a lower threshold to use emergency services to transport stroke patients and partly to preferential referral of thrombolysis candidates.