Access to acute stroke care, including telestroke, has increased

Population access to acute stroke care has significantly increased in recent years compared with prior reports, according to results of a cross-sectional study published in JAMA Network Open.

“Previous work has demonstrated variation in U.S. population access to stroke center hospitals, with nearly 20% of Americans lacking timely access to alteplase-capable hospitals in 2011,” Kori S. Zachrison, MD, MSc, of the department of emergency medicine at Massachusetts General Hospital, and colleagues wrote. “In the interim, there has been a substantial investment in both increasing the number of stroke centers and expanding the use of telestroke services. To provide an update on population-level access to stroke care, we (1) estimated the proportion of the U.S. population with access to an ED with acute stroke capabilities (ie, in a confirmed stroke center or with telestroke capacity) and (2) assessed the specific contribution of telestroke services to U.S. population access.”

Researchers identified all U.S. EDs open in 2019 using the 2019 National Emergency Department Inventory-USA, categorizing each ED as having telestroke capacity and whether it was part of a hospital stroke center. They used the census block group based on 2020 U.S. Census data as the unit of analysis and determined whether each block had access to an ED with acute stroke expertise within 60 minutes of transport time. They obtained prehospital transport times from the 2019 National Emergency Medical Services Information System.

Results showed 5,587 EDs open in the U.S. in 2019, of which 2,563 (46%) were in stroke centers and 2,505 (45%) had telestroke services in the ED. A total of 1,101 of 3,024 EDs (36%) not in a stroke center had telestroke capacity vs. 432 of 691 EDs (63%) in acute stroke-ready hospitals and 872 of 1,505 EDs (58%) in primary stroke centers. A total of 91% of the U.S. population was within 60 minutes of an ED stroke center and 90% was within 60 minutes of a telestroke ED. Further, 96% could access within 60 minutes an ED with any acute stroke capabilities. However, access differed by region, from 91% in the Mountain West to 99% in the Mid-Atlantic. Among 13,191,024 individuals (4% of the total population) without access in 60 minutes, 7,905,276 (60%) could access a nontelestroke, nonstroke center ED within 60 minutes.

“A major study limitation was self-reported telestroke capacity that was not confirmed by our study team,” Zachrison and colleagues wrote. “Despite improvements in stroke systems of care, many Americans still lack timely access to acute stroke intervention. Although the smaller, critical access hospitals serving patients in rural areas are the most likely to benefit from telestroke services, they are currently the least likely to have them. Addressing this care gap and other disparities in access will be critical to improving equitable access to acute stroke care for all Americans.”