Intravenous thrombolysis for stroke increases over time at primary stroke centers

Shyam Prabhakaran*, Maggie McNulty, Kathleen O'Neill, Bichun Ouyang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


BACKGROUND AND PURPOSE-: We evaluated the impact that duration as a primary stroke center (PSC) had on tissue-type plasminogen activator (tPA) utilization for acute ischemic stroke. METHODS-: A retrospective analysis of the Illinois Hospital Association CompData was performed identifying those patients with primary discharge diagnosis of acute ischemic stroke based on International Classification of Diseases version 9 codes. We assessed utilization of tPA by International Classification of Diseases version 9 procedure code (99.10). We categorized patients as cared for at non-PSC, PSC >1 year before, ≤1 year before, ≤1 year after, and >1 year after certification. We used generalized estimating equations to calculate adjusted odds ratios for tPA utilization by PSC category. RESULTS-: Among 119 539 acute ischemic stroke patients (mean age, 72 years; 55.2% women), tPA use was 1.9% but increased by PSC category (P<0.001): (1) non-PSC 0.9%; (2) >1 year before PSC certification 1.4%; (3) ≤1 year before certification 3.2%; (4) ≤1 year after certification 4.3%; and (5) >1 year after certification 6.5%. Adjusting for age, insurance status, admission source, year of study, region of Illinois, and hospital bed size, the odds of tPA utilization increased with advancing stage of PSC certification (highest category: adjusted odds ratio, 2.37; 95% confidence interval, 1.52-3.71). CONCLUSIONS-: Although increasing over time, stroke thrombolysis is strongly impacted by the PSC certification process. Rather than waning or stagnating, tPA utilization increases at PSC from the earliest phases of preparation through certification and subsequent maintenance.

Original languageEnglish (US)
Pages (from-to)875-877
Number of pages3
Issue number3
StatePublished - Mar 2012


  • certification
  • quality improvement
  • tissue-type plasminogen activator

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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