Aligning emergency admission and stroke center catchment areas: Association with intravenous thrombolysis rates.

Abstract

Objectives: To assess whether co-location of a Primary Stroke Center (PSC) and an Emergency Department (ED) was associated with higher intravenous thrombolysis (IVT) rates after alignment of emergency admission pathways in the Central Denmark Region.

Methods: This retrospective before-and-after cohort study compared two 6-month periods before (July 1 to December 31, 2021) and after (July 1 to December 31, 2022) co-location following a hospital merger in February 2022. Patients were identified through the Danish Stroke Center Database and linked with prehospital records. The primary outcome was the proportion of patients with acute ischemic stroke (AIS) treated with IVT. Secondary analyses included stroke mimic admissions and transport subgroups. Absolute risk differences were estimated using linear regression with robust variance estimation, and adjusted analyses used inverse probability weighting.

Results: The study included 1,950 patients with suspected stroke: 1,059 before and 891 after co-location. Among 914 patients with AIS, the IVT rate increased by 4.6 percentage points (95% confidence interval [CI] 0.1-9.1), from 12.2% (95% CI 9.2-15.2) before co-location. This increase was driven by EMS-transported patients following emergency calls, in whom the IVT rate increased by 10.2 percentage points (95% CI 0.5-19.9). In this subgroup, median door-to-needle time increased from 26.5 to 40.0 minutes (p=0.003). Stroke mimic admissions decreased from 26.3% to 17.9%.

Conclusion: Co-location of the PSC and ED was associated with higher IVT rates, particularly among EMS-transported emergency-call patients, suggesting that alignment of emergency admission pathways and stroke center catchment areas may improve access to time-critical reperfusion therapy.