Time Matters: Stroke Treatment in San Diego County's Stroke Receiving System

Background: Annually over 790,000 Americans suffer a stroke and 130,000 of them die. Locally, there are over 1,000 stroke deaths each year. Chances of full recovery or decreased disability increase when treatment is provided quickly. The emergency medical system (EMS) plays an important role in patients getting care. In 2009, the San Diego County Stroke Receiving System was established to enhance communication between EMS agencies and hospitals, to designate hospitals as Stroke Receiving Centers (SRCs), and to create the San Diego County Stroke Database for quality assurance and assessment.

Methods: 2010-2012 Stroke Receiving System data was analyzed to assess trends in mode of arrival, diagnoses, and treatment processes.

Results: There were 5,100 stroke cases per year, of which 65.7% were ischemic stroke (AIS). Among AIS cases, 30.1% arrived at a SRC within four hours of symptom onset. Of these, 27.4% received thrombolytic medication (tPA). Less than 1% of AIS cases arriving after four hours of symptom onset received tPA. Among EMS-transported AIS cases, 40.9% arrived within four hours of symptom onset. Of these, 31.8% received tPA. EMS-transported AIS cases accounted for 84.5% of all AIS cases that received tPA.

Conclusion: Cases arriving through EMS may have greater acuity, and faster arrival to a SRC may improve the chance an AIS stroke patient qualifies to receive tPA, stressing the role EMS plays in getting stroke patients to treatment. Continuing public education on recognizing signs of a stroke and seeking prompt treatment will help reduce disability and improve outcomes after a stroke.