Troubles neurologiques

A Nationwide Inpatient Sample Study of Stroke Outcomes Based on Aggressiveness to Pursue Thrombectomy: The Thrombectomy/Thrombolysis Ratio

Abstract

Fargen KM, Neal D, Batool M and Blackburn S

Background: Consensus guidelines to assist practitioners regarding patient selection for thrombectomy in acute ischemic stroke are absent. The purpose of this study is to use the Nationwide Inpatient Sample Database to evaluate the differences in patient outcomes between high-volume stroke centers that are more aggressive with using thrombectomy than those high-volume stroke center that are less aggressive. Methods: High volume stroke centers were identified for the years 2009, 2010 and 2011 in the Nationwide Inpatient Sample Database based upon having treated at least 5 patient with thrombectomy, 20 with thrombolysis, and 300 total stroke patients. Hospitals were then categorized based on the ratio of thrombectomies/thrombolyses performed each year (T/T ratio). Outcomes and mortality after thrombectomy were compared based on T/T ratio. Results: Between 2009 and 2011, 97 hospitals met inclusion criteria; there were 56,582 patients with stroke, 1,431 patients treated with thrombectomy, and 4,583 patients treated with intravenous thrombolysis at these hospitals during the study period. There were non-linear, significant associations between T/T ratio and both poor outcome (P=0.03) and mortality (P=0.01), where hospitals with the highest and lowest T/T ratios had worse outcomes and higher mortality after thrombectomy compared to moderately aggressive hospitals. Conclusion: Hospitals with moderate T/T ratios had the best clinical outcomes after thrombectomy. This data suggest the importance of both adequate treatment volumes to maintain proficiency and the use of intelligent patient selection based upon generally accepted criteria in obtaining optimal stroke outcomes after thrombectomy.