Friday, November 1, 2002

Stroke treatment evaluated

Statewide study points up ways to improve

By Tim Bonfield
The Cincinnati Enquirer

Too many Ohio residents who suffer strokes are failing to call 911 fast enough to get treatment that can prevent or reduce permanent brain damage.

Not enough hospitals are prepared to act fast enough when patients do come in on time.

Stroke warning signs:
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing.
• Sudden, severe headache with no known cause.
Some risk factors:
• High blood pressure
• Cigarette smoking
• Diabetes
• Heart disease
And not enough effort is going into education to prevent people from suffering second strokes.

As a result, many people are suffering needlessly from the nation's third-leading cause of death and No. 1 cause of severe disability, according to data from a year-long, statewide study of stroke care presented Wednesday in Cincinnati.

"We have a huge job ahead of us. Our major problem is getting people to the hospital," said Dr. Joseph Broderick, director of the Greater Cincinnati/Northern Kentucky Stroke Team.

The study analyzed 1,052 strokes reported by 40 Ohio hospitals that occurred in late 2001. The study focused on strokes caused by blood clots in the brain rather than ruptured blood vessels. Eleven of the participating hospitals were in Greater Cincinnati, 13 were in Cleveland, and 16 were randomly selected from the rest of the state.

A stroke is brain damage caused by blood clots in the brain or by ruptured blood vessels in the brain. Symptoms include sudden weakness on one side of the face, in one arm or leg, loss of sight in one eye, or difficulty speaking.

Nationwide, about 700,000 people a year suffer a stroke, according to the American Stroke Association. Strokes can be fatal, but many people live to suffer long-term paralysis, partial blindness and speech problems.

Stroke experts say a clot-busting drug called tPA, commonly used in treating heart attacks, can sharply reduce brain damage from stroke - but only if given within three hours of the onset of symptoms.

The study found large gaps between national goals for stroke care and how people actually get treated.

Only 21 percent of stroke victims actually reached a hospital emergency department within three hours of noticing symptoms.

Only 3.6 percent actually got treated with tPA. The national goal, set forth by the American Stroke Association, is 20 percent by 2008.

Only 41 percent of patients who should have had blood tests to check cholesterol levels actually got the test. And only half of those with poor scores actually got prescriptions for cholesterol-controlling medications.

Despite years of public education campaigns, 43 percent of people still cannot name a single symptom of stroke, and 32 percent cannot name a single risk factor.

Very often, people dismiss subtle signs of stroke. They lie down to see if the symptoms go away. Instead, people should call 911, Dr. Broderick said.

On Wednesday, hospitals that participated in the study got report cards showing how they compared to state averages. The results were confidential.

In general, Greater Cincinnati hospitals were more consistent about stroke care than hospitals statewide, Dr. Broderick said.

However, even here, stroke-related services can range widely.

At some hospitals, every stroke victim who smokes (a major risk factor) gets information about smoking cessation programs. But at others, no smoking cessation information is dispensed, Dr. Broderick said.

Hospitals also vary in whether they keep supplies of tPA in the emergency room, whether CT scans can be performed within 15 to 25 minutes of arrival, how quickly neurosurgeons can be available, and in the availability of inpatient physical and occupational therapy services for follow-up care.

Ohio, Michigan, Massachusetts and Georgia were selected last year by the federal Centers for Disease Control and Prevention as pilot states for creating statewide registries of stroke patients and their treatment outcomes.


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