The following is a summary of “Trends in intravenous thrombolysis utilization for acute ischemic stroke based on hospital size: Paul Coverdell National Acute Stroke Program, 2010–2019,” published in the May 2023 issue of Emergency Medicine by Asaithambi, et al.

The utilization of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) has been on the rise, accompanied by improvements in door-to-needle times (DNTs). However, smaller hospitals have shown lower rates of IVT utilization or no utilization at all. For a study, researchers sought to investigate the impact of hospital size on trends in IVT utilization for AIS using data from a multistate stroke registry.

Data from the Paul Coverdell National Acute Stroke Program (PCNASP) was analyzed to examine trends in IVT utilization for AIS patients from 2010 to 2019, based on hospital size. Hospitals were categorized into quartiles based on their size. The study assessed the influence of hospital size on DNTs and overall IVT utilization.

The study included 530,828 AIS patients (mean age 70.3 ± 0.02 years, 50.4% men) from 540 participating hospitals. No significant trend in IVT utilization was observed among hospitals in the first quartile (P = 0.1005). However, hospitals in the second, third, and fourth quartiles showed significant increasing trends in IVT utilization (P < 0.001 for all). All quartiles exhibited significant improvements in DNTs ≤60 min (P< 0.0001), but only hospitals in the second, third, and fourth quartiles demonstrated significant improvements in DNTs ≤45 min (P < 0.0001).

Based on the analysis using a stroke registry, larger hospitals showed an increasing trend in IVT utilization for AIS. There was an overall improvement in achieving DNTs ≤60 min, but hospitals in the second, third, and fourth quartiles demonstrated significant improvements in achieving DNTs ≤45 min. The findings suggested that hospital size may impact the utilization of IVT and the timeliness of treatment in AIS.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000773