In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
Abstract:
Introduction: Recent randomized clinical trials have demonstrated benefit for treatment with endovascular stroke therapy (EST) and thrombolysis (IV-tPA) in late presenting acute ischemic stroke (AIS) patients using CT perfusion (CTP). The real-world utilization and availability of this advanced imaging modality is unknown. Methods: We identified all inpatient hospitalizations with a primary diagnosis of AIS using ICD-9/10 codes in Texas Medicare claims (2014-2017) and 5% national Medicare sample (2014-2017) and evaluated imaging utilization given at the Emergency Department (ED) prior to admission. Imaging and treatments were identified using CPT and procedure codes. Primary endpoint was ED-based imaging utilization. EST and CTP-capable hospitals were defined as those performing at least one EST or CTP within that calendar year. Results: In the Texas cohort, among 50,797 admissions for AIS, 54% were female, median age was 77 [IQR 69-84], and 78% were white. 2% received EST and 9% received IV-tPA. 76% of AIS patients and 80% of those with EST received ED-based neuro-imaging at the treating hospital (Fig. 1). 58% of all AIS patients were evaluated in EST-capable hospitals. 75% of all AIS patients, 54 % of those with EST, and 70% of those with IV-tPA were evaluated at non-CTP-capable hospitals. 9% of IV-tPA and 17% of EST-treated patients underwent CTP; rates of MRI were greater (Fig. 1). These findings were maintained in the nationwide sample. Among 37,507 admissions for AIS, CTA was performed in 17%, MRI in 30%, and CTP in 3%. Among the 3% of AIS patients treated with EST, CTA was performed in 65%, MRI in 66%, and CTP in 14%. Conclusion: In this population-based cohort, three out of four AIS admissions and half of EST procedures were at non-CTP performing hospitals. The limited availability and utilization of CTP suggest that an alternative imaging paradigm (e.g. MRI) may be beneficial in delayed time-window EST and thrombolysis.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.51.suppl_1.TP70
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2020
detail.hit.zdb_id:
1467823-8
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