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What matters in stroke treatment? Location, location, location

February 24, 2010 |  1:12 pm

Many Americans live far from primary stroke centers, a new study finds, putting them in possible danger if care can't be given quickly.

Kxe96mnc The study found that about 55% of people have access to a primary stroke center within an hour, about 43% are within 45 minutes, and a little less than a quarter are within 30 minutes -- and that's without emergency medical services crossing state lines. Even if EMS were to cross state lines, those percentages would rise very slightly. According to the research, that means more than 135 million people do not have access within an hour to a stroke facility.

Seconds count when a stroke strikes -- obtaining clot-busting drugs is essential, and the more time passes, the potentially worse the outcome for the patient.

Dr. Brendan Carr, senior author of the study and an assistant professor of emergency medicine and biostatistics and epidemiology at the University of Pennsylvania, presented the findings at the American Stroke Assn.'s International Stroke Conference this week in San Antonio. Data came from the U.S. Census Bureau, and authors also took note of hospitals that have been certified as primary stroke centers. They factored in variables such as drive time, ambulance dispatch, and response times between various areas and the nearest stroke center.

Looking at specific regions, researchers found that those who live in the Northeast had the best chance of getting to a stroke center by ground within an hour, followed by those in the Midwest, then the South and West. Five states had no access within the state to a stroke center within an hour, but those in the District of Columbia were in luck -- everyone there could get to a stroke center within 60 minutes.

Better chances of survival, say Carr and his co-authors, may come from allowing ambulances to cross state lines, establishing an inter-hospital referral network, and designing incentives to build stroke centers in areas that are lacking. They calculated that transporting people to stroke centers via air ambulance could improve travel time -- 79% of people could reach one within an hour.

"Strokes often strike without warning," Carr said in a new release. "We are all at risk, and the therapy is time-critical. Data like these brings us closer to taking a big step in the development of not only a more robust stroke system, but of an emergency care system that can serve anyone, no matter where they are in the country. Using technology, we hope to develop new ways to connect hospitals to each other so that instead of always delivering the patient to the doctor, we will be able to deliver the doctor to the patient."

-Jeannine Stein

Photo credit: Eric Schultz / Associated Press

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