Time to tPA and Associations with 30 day Readmission and Mortality and 1 year Mortality. Público

Abstract

Background

The southeastern US has the dubious distinction of having the highest US concentration of stroke patients with the highest morbidity and mortality in the U.S. Identifying factors that mitigate the devastating effects of acute stroke and reduce readmissions would have a large impact on patients, families, and society. Shortening time to Tissue Plasminogen Activator (tPA) administration is one factor that may improve patient outcomes.

Objectives

Among acute ischemic stroke patients, examine the association between Emergency Department (ED) door to tPA (dtPA) infusion time and 30-day readmissions and mortality, as well as 1-yr mortality, using a cohort created by data linkage among the Georgia Coverdell Acute Stroke Registry (GCASR) and other Georgia databases. 

Methods

A retrospective cohort of acute stroke patients receiving tPA in the ED was identified from the GCASR database (2008-2013) and linked to Georgia hospital discharge and death records using Fine-grained Record Integration and Linkage software (FRIL).  Risk factors for 30-day mortality and admissions were analyzed using multivariable logistic regression.

Results

2691 patients were available for primary outcome analysis and linkage.  DtPA time was not significantly associated with 30-day readmission in crude or adjusted analysis. DtPA time was associated with 30-day mortality in crude analysis: 61-90 minute OR 1.59 (95% confidence interval 1.20-2.10) and 91+ minute OR 1.43 (95% confidence interval 1.05-1.94). DtPA time was also associated with 1 year mortality in crude analysis: 61-90 minute OR 1.59 (95% confidence interval 1.27-1.98) and 91+ minute OR 1.43 (95% confidence interval 1.05-1.94).

Conclusion

Door-to-tPA time was associated with decreased 30-day and 1-year mortality though we found no evidence of an association with decreased 30-day readmission.. Our results strengthen the concept that door to tPA time is an important clinical target for process initiatives as it may decrease overall stoke mortality.

Table of Contents

INTRODUCTION……………………………………………………………………….         1

BACKGROUND……………………………………………………………………….... 2

METHODS……………………………………………………………………………..... 8

RESULTS………………………………………………………………………………….. 12

DISCUSSION…………………………………………………………………………….. 14

REFERENCES…………………………………………………………………………… 17

FIGURE AND TABLES……………………………………………………….……... 20

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, General
Palavra-chave	mortality readmission FRIL tissue plasminogen activator stroke
Committee Chair / Thesis Advisor	Wright, David W., Emory University
Committee Members	Manatunga, Amita, Emory University Pennington, Audrey F., Emory University

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