Nationwide Differences in Care and Outcomes of Acute Ischemic Stroke

Background: Acute Ischemic Stroke (AIS) remains a leading cause of mortality and morbidity in United States, and poses a major socio-economic burden. Efforts are underway to standardize systems of care for acute stroke treatment. We aim to assess if, despite the attempts towards standardization, regional difference in stroke care practice pattern, cost and/ or outcomes persist. Methods: Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database was reviewed from 2002 to 2014. Hospitalizations with AIS were identified using ICD-9-CM codes 433.xx-436, tPA use by procedure code 99.10. Care is determined based on tPA utilization, length of stay, and cost of hospitalization. Outcomes are determined based on discharge disposition (home or facility) and death. These were further analyzed based on regions; Northeast, South, Midwest and West. Multivariate linear regression model and Cochran Armitage trend test used for the analysis. Results: AIS admissions increased throughout the US, more so in the South. There is an increase in tPA utilization all regions, which is significantly higher in the West compared to other regions. Midwest and South have significantly lower cost of hospitalization compared to West despite having higher length of stay. (Graph). Conclusion: AIS care is noted to be remarkably non-uniform across the USA. This lack of uniformity seems to affect outcomes. Further studies are required to determine the causation of these findings.