Stroke centers with advanced Joint Commission certifications did provide better care and outcomes for patients, the Get With the Guidelines (GWTG) stroke registry showed, and more and more hospitals appeared to be on their way to raising their status.
Among U.S. hospitals offering reperfusion therapy to stroke patients, certified thrombectomy-capable stroke centers (TSCs) and comprehensive stroke centers (CSCs) both beat primary stroke centers (PSCs) for door-to-needle times, successful revascularization, and rates of in-hospital death or discharge to hospice on multivariable analysis.
With the highest and most demanding certification, CSCs were better than PSCs in terms of door-to-puncture times and the proportion of patients discharged home or to rehabilitation, reported Radoslav Raychev, MD, of the University of California Los Angeles at the American Stroke Association International Stroke Conference held virtually and in New Orleans.
Notably, although CSCs handled the bulk of thrombectomies, 22% of all endovascular therapy (EVT) cases during the study period were still performed at PSCs. “Surprisingly,” some of these lower-capability centers were reaching 150 EVTs per year even though they are only required to provide IV tissue plasminogen activator (tPA), Raychev’s group observed.
It can be presumed that some of these centers were trying to ramp up their volume to elevate their certification in the near future, but it’s unclear which ones those were, Raychev said.
Nevertheless, he urged further quality improvement efforts escalating PSCs that meet EVT volume requirements to higher certification status, given the better performance across process and clinical metrics by CSCs and TSCs.
Using nationwide GWTG registry data spanning 2018 to 2020, Raychev and colleagues found 383 sites meeting a minimum EVT volume and holding stroke center certification: 169 PSCs, 185 CSCs, and 29 TSCs.
There were 84,903 stroke patients included in the study (median age 70, roughly split between sexes). Most commonly, these individuals went to hospitals in the South.
CSCs had the most patients transferred in (33.4%) and people arriving on mobile stroke units (0.6%). These patients also spent the longest time from last known well to arrival, at a median 2.3 hours. Baseline NIH Stroke Scale scores tended to be highest for this group as well, at 12.0.
TSCs treated patients who were significantly older than other groups (median age 72) and more likely to be on private/VA insurance (47.3%) rather than uninsured (2.9%).
Risk of symptomatic intracerebral hemorrhaging was similar across all centers treating stroke patients with IV thrombolysis and/or EVT.
The study was limited by its reliance on retrospective, site-reported data and the classification of stroke centers only by Joint Commission and DNV certifications.
Raychev also cautioned that TSCs were relatively few in the study, as this was a new certification that was only introduced in 2018.
Raychev disclosed ties to Boehringer Ingelheim, Rapid Medical, Spartan Micro, and Phenox.