Use of Thrombolysis in Acute Ischemic Stroke

Analysis of the Nationwide Inpatient Sample 1999 to 2004

H. Christian Schumacher, Brian T. Bateman, Bernadette Boden-Albala, Mitchell F. Berman, J. P. Mohr, Ralph L. Sacco, John Pile-Spellman

Research output: Contribution to journalArticle

Abstract

Study objective: The aim of this study is to characterize hospital and patient characteristics associated with administration of thrombolysis in acute ischemic stroke patients in the United States. Methods: This retrospective, observational, cohort study used data from the Nationwide Inpatient Sample, an administrative discharge database. A total of 366,194 hospitalizations admitted through the emergency department with a primary diagnosis of acute ischemic stroke were selected for analysis. The primary outcome considered in this study is whether the patient received thrombolytic therapy on hospital day 0 or 1. Results: Thrombolysis was used in 1.12% (95% confidence interval [CI] 0.95% to 1.32%) of ischemic stroke hospitalizations. Most hospitals (69.5%; 95% CI 68.4% to 70.6%) treating ischemic stroke patients did not use thrombolysis during the study period. For the hospitals that used thrombolysis, the mean annual number of patients treated with thrombolysis per hospital was 3.06 (95% CI 2.68 to 3.44). In the binary logistic regression analysis, hospital characteristics associated with high use of thrombolysis were teaching hospital status and increasing number of stroke patients treated annually. Patient characteristics associated with higher use of thrombolysis were age younger than 55 years, male sex, and low comorbidity as measured by the modified Charlson Index; white race; and private self-pay health insurance. Conclusion: Use of thrombolysis for ischemic stroke in the United States from 1999 to 2004 was infrequent and showed significant differences, depending on hospital and patient demographic characteristics.

Original languageEnglish (US)
Pages (from-to)99-107
Number of pages9
JournalAnnals of Emergency Medicine
Volume50
Issue number2
DOIs
StatePublished - Aug 2007

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Inpatients
Stroke
Confidence Intervals
Hospitalization
Thrombolytic Therapy
Health Insurance
Teaching Hospitals
Observational Studies
Hospital Emergency Service
Comorbidity
Cohort Studies
Logistic Models
Regression Analysis
Demography
Databases

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Use of Thrombolysis in Acute Ischemic Stroke : Analysis of the Nationwide Inpatient Sample 1999 to 2004. / Schumacher, H. Christian; Bateman, Brian T.; Boden-Albala, Bernadette; Berman, Mitchell F.; Mohr, J. P.; Sacco, Ralph L.; Pile-Spellman, John.

In: Annals of Emergency Medicine, Vol. 50, No. 2, 08.2007, p. 99-107.

Research output: Contribution to journalArticle

Schumacher, H. Christian ; Bateman, Brian T. ; Boden-Albala, Bernadette ; Berman, Mitchell F. ; Mohr, J. P. ; Sacco, Ralph L. ; Pile-Spellman, John. / Use of Thrombolysis in Acute Ischemic Stroke : Analysis of the Nationwide Inpatient Sample 1999 to 2004. In: Annals of Emergency Medicine. 2007 ; Vol. 50, No. 2. pp. 99-107.
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abstract = "Study objective: The aim of this study is to characterize hospital and patient characteristics associated with administration of thrombolysis in acute ischemic stroke patients in the United States. Methods: This retrospective, observational, cohort study used data from the Nationwide Inpatient Sample, an administrative discharge database. A total of 366,194 hospitalizations admitted through the emergency department with a primary diagnosis of acute ischemic stroke were selected for analysis. The primary outcome considered in this study is whether the patient received thrombolytic therapy on hospital day 0 or 1. Results: Thrombolysis was used in 1.12{\%} (95{\%} confidence interval [CI] 0.95{\%} to 1.32{\%}) of ischemic stroke hospitalizations. Most hospitals (69.5{\%}; 95{\%} CI 68.4{\%} to 70.6{\%}) treating ischemic stroke patients did not use thrombolysis during the study period. For the hospitals that used thrombolysis, the mean annual number of patients treated with thrombolysis per hospital was 3.06 (95{\%} CI 2.68 to 3.44). In the binary logistic regression analysis, hospital characteristics associated with high use of thrombolysis were teaching hospital status and increasing number of stroke patients treated annually. Patient characteristics associated with higher use of thrombolysis were age younger than 55 years, male sex, and low comorbidity as measured by the modified Charlson Index; white race; and private self-pay health insurance. Conclusion: Use of thrombolysis for ischemic stroke in the United States from 1999 to 2004 was infrequent and showed significant differences, depending on hospital and patient demographic characteristics.",
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AB - Study objective: The aim of this study is to characterize hospital and patient characteristics associated with administration of thrombolysis in acute ischemic stroke patients in the United States. Methods: This retrospective, observational, cohort study used data from the Nationwide Inpatient Sample, an administrative discharge database. A total of 366,194 hospitalizations admitted through the emergency department with a primary diagnosis of acute ischemic stroke were selected for analysis. The primary outcome considered in this study is whether the patient received thrombolytic therapy on hospital day 0 or 1. Results: Thrombolysis was used in 1.12% (95% confidence interval [CI] 0.95% to 1.32%) of ischemic stroke hospitalizations. Most hospitals (69.5%; 95% CI 68.4% to 70.6%) treating ischemic stroke patients did not use thrombolysis during the study period. For the hospitals that used thrombolysis, the mean annual number of patients treated with thrombolysis per hospital was 3.06 (95% CI 2.68 to 3.44). In the binary logistic regression analysis, hospital characteristics associated with high use of thrombolysis were teaching hospital status and increasing number of stroke patients treated annually. Patient characteristics associated with higher use of thrombolysis were age younger than 55 years, male sex, and low comorbidity as measured by the modified Charlson Index; white race; and private self-pay health insurance. Conclusion: Use of thrombolysis for ischemic stroke in the United States from 1999 to 2004 was infrequent and showed significant differences, depending on hospital and patient demographic characteristics.

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