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Several factors implicated in higher than average stroke rates in northwestern U.S.
Shultis W. Stroke. 2010;doi:10.1161/strokeaha.110.594374.
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Inadequate personnel and lack of stroke protocols were cited in a recent survey of rural and urban hospitals in the northwestern United States and may help to explain the significantly higher age-adjusted stroke rate of adults 45 years or older in that region.
“This survey represents the first comprehensive regional assessment of stroke care capacity and services both in the Northwest region and the whole United States,” the researchers wrote in their study.
They surveyed area hospitals with an ED in Alaska, Idaho, Montana, Oregon and Washington, of which 213 of the 279 eligible hospitals (76.3%) returned completed questionnaires. Of the responding hospitals, 58 (27%) served primarily urban communities and 155 (73%) served predominantly rural communities.
According to researchers, two-thirds of responding hospitals did not have the necessary personnel, one-third lacked necessary neuroimaging equipment and one-fourth were functioning without written ED and tissue plasminogen activator (tPA) stroke protocols. Additionally, The Joint Commission’s primary stroke center certification, neuroimaging services, neurologist availability, radiologist availability, ED stroke protocol availability, tPA protocol availability and tPA administration for stroke at least once in the past year were less common in rural hospitals than in urban hospitals.
“The findings have confirmed the need to focus on strengthening stroke personnel, increasing access to care and promoting written protocols, especially in rural settings,” the researchers commented in the concluding statement of their study. “Additionally, promoting stroke center certification, increasing the number of stroke registries throughout the region, encouraging use of inpatient stroke care protocols in rural hospitals, and conducting ongoing stroke care capacity and services surveys is highly recommended.”
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