Featured Research

from universities, journals, and other organizations

Hospitals with neurology residency programs more likely to administer life-saving stroke drugs

Date:
November 6, 2013
Source:
Johns Hopkins Medicine
Summary:
Stroke patients treated at hospitals with neurology residency programs are significantly more likely to get life-saving clot-busting drugs than those seen at other teaching or non-teaching hospitals, new research suggests.

Stroke patients treated at hospitals with neurology residency programs are significantly more likely to get life-saving clot-busting drugs than those seen at other teaching or non-teaching hospitals, new Johns Hopkins-led research suggests.

Related Articles


The findings, described online last week in the journal Neurology, suggest that patients at academic medical centers with neurology residency programs likely benefit from having stroke specialists on hand 24 hours a day, seven days a week. These physicians have more experience with the use of tissue plasminogen activator (tPA) and are likely more confident in using the stroke treatment, which can be deadly if used in the wrong situations, the researchers say.

"The use of tPA within three hours of stroke symptom onset increases the chances of a better outcome by 30 percent and has revolutionized stroke treatment," says study leader Yogesh Moradiya, M.D., a neuro-critical care fellow in the Department of Neurology at the Johns Hopkins University School of Medicine. "But the data show there is a massive underutilization of this drug, which is considered the gold standard of treatment for patients with the most common type of stroke. And our research finds that where you are treated seems to determine whether or not you receive it."

Moradiya conducted the research with colleagues at SUNY Downstate Medical Center in Brooklyn, N.Y., when he was a neurology resident there.

The drug tPA is used only for patients with ischemic stroke, the most common type of stroke, which occurs as a result of an obstruction in a blood vessel supplying blood to the brain. It should not be used in cases of hemorrhagic stroke, marked by bleeding in the brain as the result of a broken blood vessel. Roughly 700,000 Americans each year suffer strokes, which may cause death or serious disability in the form of weakness, loss of sensation, and difficulty with speaking, seeing, or walking.

Nationwide, Moradiya says, approximately 5 percent of ischemic stroke patients receive tPA, which is injected into a vein only after a CT scan is quickly done to rule out hemorrhagic stroke. Researchers believe that approximately 15 percent of ischemic stroke patients could benefit from tPA. The decision to give the clot-busting drug comes after physicians also consider a variety of factors that could increase the risk of deadly bleeding, including size of the stroke, the patient's other illnesses and age.

In the new study, Moradiya and his colleagues analyzed 11 years of data from the U.S. Department of Health and Human Services' National Inpatient Sample, looking at more than 700,000 cases of ischemic stroke. Over the study period, they found that more than 71,000 stroke patients were treated at hospitals with neurology residency programs (10 percent), 207,208 were treated at other teaching hospitals (29 percent), and the rest were treated at non-teaching (community) hospitals. The rate of tPAuse ranged from .96 percent of stroke patients at the 140 hospitals with neurology residency programs in 2000 to 6.25 percent in 2010, from .82 percent in other teaching hospitals to 4.86 percent over the time period, and from .82 percent to 3.83 percent at non-teaching hospitals.

When tPA was first widely adopted, Moradiya says, physicians felt that very old patients, those 80 and older, should not be treated with tPA. Later research, however, found that these elderly patients did just as well as younger ones, so many hospitals have routinely given them the clot-buster since. The new study found that this population routinely gets tPA at the same rate as younger patients at neurology residency program hospitals, but at much lower rates at other hospitals.

"As patients get older, the rates of tPA utilization at hospitals without neurology residency programs go down in a straight line with advancing age," Moradiya says.

He says the reluctance to give tPA at those hospitals could be related to the dangers associated with the drugs. In 6 percent of cases, he says, the drug can cause severe bleeding, but those risks must be weighed against the harm of doing nothing. He says physicians who don't give tPA often may be less up-to-date with recommendations for its proper use, and therefore fearful of administering it, especially to older, sicker patients.

Given his findings, Moradiya says he believes it would be valuable for physicians in hospitals without neurology residency programs to receive continuing education on the current research on tPA in an attempt to get the life-saving medication to appropriate patients more often.

People having strokes typically don't have an option of where to be taken for treatment, as many emergency medical services deliver them to the nearest hospital with a stroke unit (if there is one nearby. Moradiya says it would be premature to suggest that patients try to be seen at hospitals with neurology residency programs if they are, say, 30 minutes further away. The trade-off in wasted time could be the difference in outcome in an instance where every minute counts. But if future research confirms his results, he says he could see a value in transporting stroke victims to a hospital where it is much more likely they will receive tPA.


Story Source:

The above story is based on materials provided by Johns Hopkins Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. Y. Moradiya, H. Crystal, H. Valsamis, S. R. Levine. Thrombolytic utilization for ischemic stroke in US hospitals with neurology residency program. Neurology, 2013; DOI: 10.1212/01.wnl.0000436946.08647.b5

Cite This Page:

Johns Hopkins Medicine. "Hospitals with neurology residency programs more likely to administer life-saving stroke drugs." ScienceDaily. ScienceDaily, 6 November 2013. <www.sciencedaily.com/releases/2013/11/131106131840.htm>.
Johns Hopkins Medicine. (2013, November 6). Hospitals with neurology residency programs more likely to administer life-saving stroke drugs. ScienceDaily. Retrieved December 20, 2014 from www.sciencedaily.com/releases/2013/11/131106131840.htm
Johns Hopkins Medicine. "Hospitals with neurology residency programs more likely to administer life-saving stroke drugs." ScienceDaily. www.sciencedaily.com/releases/2013/11/131106131840.htm (accessed December 20, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Saturday, December 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

The Best Tips to Curb Holiday Carbs

The Best Tips to Curb Holiday Carbs

Buzz60 (Dec. 19, 2014) It's hard to resist those delicious but fattening carbs we all crave during the winter months, but there are some ways to stay satisfied without consuming the extra calories. Vanessa Freeman (@VanessaFreeTV) has the details. Video provided by Buzz60
Powered by NewsLook.com
Sierra Leone Bikers Spread the Message to Fight Ebola

Sierra Leone Bikers Spread the Message to Fight Ebola

AFP (Dec. 19, 2014) More than 100 motorcyclists hit the road to spread awareness messages about Ebola. Nearly 7,000 people have now died from the virus, almost all of them in west Africa, according to the World Health Organization. Video provided by AFP
Powered by NewsLook.com
Researchers Test Colombian Village With High Alzheimer's Rates

Researchers Test Colombian Village With High Alzheimer's Rates

AFP (Dec. 19, 2014) In Yarumal, a village in N. Colombia, Alzheimer's has ravaged a disproportionately large number of families. A genetic "curse" that may pave the way for research on how to treat the disease that claims a new victim every four seconds. Duration: 02:42 Video provided by AFP
Powered by NewsLook.com
The Best Protein-Filled Foods to Energize You for the New Year

The Best Protein-Filled Foods to Energize You for the New Year

Buzz60 (Dec. 19, 2014) The new year is coming and nothing will energize you more for 2015 than protein-filled foods. Fitness and nutrition expert John Basedow (@JohnBasedow) gives his favorite high protein foods that will help you build muscle, lose fat and have endless energy. Video provided by Buzz60
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins