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Study shows citywide policy may help stroke patients recover

Updated: July 3, 2013 10:46AM

A citywide policy enacted in 2011 — involving Chicago ambulance crews taking suspected stroke patients directly to accredited hospitals with accredited stroke centers — was associated with increased usage of a therapy that can reverse the effects of a stroke if received in time, according to a study published in the journal JAMA Neurology on Monday.

Before the change, rates of stroke patients getting what’s known as intravenous tPa was 3.8 percent of all patients. After, it improved to 10.1 percent.

Intravenous tissue plasminogen activator (tPa) is used to restore blood flow through blocked arteries that occurs when someone has an acute ischemic stroke. But it needs to be administered within 4.5 hours of the time a stroke happens in order to be effective.

The study, led by Dr. Shyam Prabhakaran at Northwestern University, is the best indication yet that the creation of an established stroke system in Chicago has had a positive effect on stroke patients.

Before the changes went into effect in 2011, emergency medical services (EMS) in Chicago used to take people with suspected stroke to the nearest hospital, whether or not it was a primary stroke center. Some regions in Illinois still have that policy, but are in the process of changing that.

A primary stroke center is defined as a hospital-based center with the resources and processes to care for acute stroke patients. They have to be certified as such by The Joint Commission or the Healthcare Facilities Accreditation Program . In 2007, the Chicago Area Stroke Taskforce – which included Prabhakaran, other doctors from Northwestern and the University of Chicago Medicine EMS medical director – was formed to implement a stroke system of care for the region.

Eventually, they came up with a plan to have the EMS bypass stroke patients and head straight to the primary stroke centers – the same recommendation that the American Heart Association’s (AHA) Scientific Council for Stroke had put forth in 2007.

The primary EMS provider in Chicago is the Chicago Fire Department. They could not immediately be reached for comment.

Others policies involved educating paramedics to spot the signs of a stroke and alert hospitals immediately so doctors could prepare to administer potentially lifesaving care soon after a patient arrived.

In the study, Prabhakaran and other researchers looked at admitted patients with stroke and transient ischemic attack in 10 primary stroke hospitals in Chicago between September 2010 and August 2011 – six months before and six months after the change began on March 1, 2011.

The study based its findings on 1,075 admissions for stroke and transient ischemic attack in the period before the change and 1,172 admissions after.

In addition to the improved tPa findings for stroke patients, use of emergency medical services for these patients increased from 30.2 percent to 38.1 percent and emergency medical services pre-notification increased from 65.5 percent to 76.5 percent after implementation, the study found.

Prabhakaran, an associate professor in Ken and Ruth Davee Department of Neurology and Medical Social Sciences at Northwestern, said the changes that were made was “a piece of the puzzle” in improving the outcome of stroke patients. But he noted that there’s still room for improvement, such as getting stroke victims to call 911 immediately when they have symptoms.

Stroke symptoms include face drooping, arm weakness and speech difficulty.

Stroke affects approximately 9,000 Chicagoans annually. In the United States, more than 600,000 people have a stroke and about 160,000 die each year.

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