5:30 p.m. #P123 – Strategy improves clot-busting treatment rates. The proportion of ischemic stroke patients receiving thrombolytic drugs (clot-busters) – which must be delivered within three hours of symptom onset – is low. The Heart and Stroke Foundation of Ontario initiated the Coordinated Stroke Strategy (CSS) in May 1998 in an effort to improve access to thrombolytics throughout the province. Only five stroke patients received thrombolytic treatment in London, Ontario, between January 1996 and June 3, 1999. A stroke strategy coordinator was hired in February 1999 to reorganize hospital treatment protocols. Stroke fellows or stroke neurologists treated patients. The treatment rate rose to 3.5 patients per month during the last half of 1999, then jumped to an average of six patients per month following a public awareness campaign that began in February 2000. The average number of patients treated for stroke in the community rose to seven patients per month during the first half of 2001. A 2000 independent audit showed that of 82 consecutive ischemic stroke patients, 25 (30 percent) received thrombolytics. Researchers conclude that the CSS led to a dramatic increase in the stroke treatment rate and credit the “critical” role of the stroke facilitator’s efforts to reorganize protocols and the public awareness campaign.
Brian Silver, M.D., Henry Ford Hospital, Detroit, Mich., (313) 916-9107; e-mail: silver@neuro.hfh.edu.
5:30 p.m. #P102 – Intracerebral hemorrhage rates vary by gender, geography. The hospitalization rate for intracerebral hemorrhage (ICH) – a potentially fatal bleeding of the brain – is greatest in the southern United States and among men. However, women are more likely to die in the hospital or to be discharged to a long-term care center. These are among the findings by researchers at the National Institute for Neurological Disorders and Stroke (NINDS) who reviewed hospital discharge data on ICH for 1990 – 99. It’s among the first long-term studies to focus on ICH hospitalization rates. An estimated 540,901 people over age 45 were hospitalized for ICH during the 10-year period, an average of 63.9 per 100,000 individuals each year. Slightly more men were hospitalized than women, 64.8 per 100,000 compared to 63.1, respectively, and the hospitalization rate in southern states at 67.5 per 100,000 was higher than in other parts of the country. The researchers found that 31.8 percent of men and 22.3 percent of women returned home after their hospital stay, while 15.4 percent of men and 23.7 percent of women were discharged to a long-term care facility. Approximately 29.8 percent of men and 33.6 percent of women died during their hospital stay and 65 percent of all deaths occurred within the first three days of hospital admission. Among those patients who died while hospitalized, death rates were highest for older patients, women, Caucasian patients and those who received mechanical ventilation, researchers say.
John K. Lynch, D.O., NINDS, Bethesda, Md. (301) 496-1187; lynchj@ninds.nih.gov.