Stroke. 2026 Mar 13. doi: 10.1161/STROKEAHA.125.053711. Online ahead of print.
ABSTRACT
BACKGROUND: Timely identification and treatment of acute ischemic stroke (AIS) in the emergency department is imperative. We sought to report the change over time in emergency department-based AIS treatment in a community without an academic medical center through a mixed-methods approach.
METHODS: As part of the longitudinal population-based BASIC (Brain Attack Surveillance in Corpus Christi) project, Nueces County residents 45+ years old with AIS treated in an emergency department were identified, excluding patients with in-hospital events. Logistic regression was used to model changes over time from 2012 to 2022, treating time continuously, for the binary outcomes National Institutes of Health Stroke Scale score documentation, transfer to an out-of-area facility, thrombolytic (tPA/TNK [tissue-type plasminogen activator/tenecteplase]) utilization, and arrival method. Trends for neurology consults and telestroke consults were evaluated from 2015 to 2022 based on data availability. Logistic regression models accounted for subject repeated measures and within-hospital clustering. Rapid qualitative analysis procedures were used to analyze semistructured interviews of emergency medicine (EM) physicians.
RESULTS: A total of 5388 strokes were included. National Institutes of Health Stroke Scale documentation by provider increased by 12.9% (95% CI, 0.057-0.202). The overall proportion of neurology consultation increased by 26% (95% CI, 0.159-0.360). Among these, the proportion of telestroke consults increased by 34.2% (95% CI, 0.218-0.465). Patient transfer to an out-of-area facility saw a peak around 2020 (3.2%) that declined by 2022 (0.0%). tPA/TNK treatment increased by 5.5%, but was not statistically significant (95% CI, -0.006 to 0.116). Arrival to the emergency department by emergency medical services decreased by 9.4% (95% CI, -0.181 to -0.007). Fifty-two practicing emergency medicine physicians in Nueces County were recruited via email between April and October 2024, yielding 18 interviews. Participants described improved organization of stroke care and confidence in treating AIS.
CONCLUSIONS: There have been positive changes in AIS treatment from the emergency medicine perspective, suggesting the success of assertive treatment protocols in this real-world community.
PMID:41822963 | DOI:10.1161/STROKEAHA.125.053711
