Acute stroke care in non-urban emergency departments

Objective: To evaluate the practice patterns for stroke care in rural emerg ency departments (ED). Methods: The authors prospectively evaluated clinica l practice decisions for all ED patients in two non-urban East Texas commun ities using active and passive surveillance methods. Data collected include d demographics, risk factors, symptoms, and treatment. Data analysis consis ted of descriptive statistics and logistic regression analysis. Results: Du ring the study period, 429 patients presented with validated strokes. Risk factors included hypertension (65%), previous stroke (41%), coronary artery disease (33%), diabetes (25%), current smoking (17%), and atrial fibrillat ion (11%). In the ED, neurology consultation occurred in 32%, head CT in 88 %, and ECG in 85%. Heparin was used in 9% and 5% received aspirin. Blood pr essure was lowered in 19% from a mean high of 189(+/- 38)/97(+/- 26), avera ge reduction 34 points (18%) systolic. Motor symptoms were more likely to p rompt a neurology consultation (OR = 2.47). Heparin was used more commonly for patients with atrial fibrillation (OR = 2.93). Socioeconomic factors di d not alter care. IV recombinant tissue plasminogen activator was used in 1 .4% of ischemic stroke cases. Conclusions: Acute stroke care in this repres entative non-urban community frequently does not follow published guideline s or clinical trial results. Whereas a high percentage of patients receive CT, aggressive blood pressure treatment occurs commonly and at pressures be low current recommendations. The use of heparin is common, more so than asp irin treatment. These facts argue for educational interventions aimed at no n-urban physicians to improve evidence-based medical practice.