Mission Hospital's code stroke team: implications for an aging population.

Objective: To evaluate the success of an acute stroke program designed to streamline the evaluation and treatment of acute ischemic stroke patients, with particular regard to the risk of symptomatic intracerebral hemorrhage and discharge disposition based on age in those patients treated with acute stroke intervention.

Methods: Retrospective review of patients at Mission Hospitals in Asheville, North Carolina from January 2006 to October 2007 with sudden neurological deficit identified within six hours of onset. Data were obtained from Mission Hospital's in-house spreadsheet database and the American Stroke Association's "Get With the Guidelines" (GWTG) database. Patients were evaluated by a code stroke protocol that included early involvement of stroke-treating neurologists. A chart review of all code stroke patients established the number of patients treated with acute intervention, disposition, and follow-up information.

Results: Over the 22-month study period, there were 568 code stroke evaluations. Of all code stroke patients, 27.1% (n=154) were treated with an acute intervention for stroke, usually intravenous thrombolysis. We analyzed treated patients on the basis of age, with the younger age group (YAG) being 79 years or younger and the older age group (OAG) being 80 years or older. Of the patients treated with acute intervention, 58 (37.7%) were OAG. Discharge disposition varied with age: 42.7% of YAG patients went home alone or with home health assistance, whereas only 20.7% of OAG patients went home alone or with home health assistance. The inhospital mortality rate was 10.4% for YAG patients and 22.4% for OAG patients. Symptomatic intracerebral hemorrhage was noted in one patient under age 80 and one patient over age 80. This is a symptomatic hemorrhage rate of 1.3%.

Limitations: This was a retrospective, observational, post hoc analysis without a standardized follow-up program.

Conclusions: Our Code Stroke Team, with an inpatient neurology service, increased the proportion of stroke patients treated with acute intervention benchmarking with other GWTG participating hospitals in this time period. Aggressive stroke treatment with thrombolytic therapy in patients over age 80 did not show an increased rate of symptomatic intracerebral hemorrhage.