Study highlights success, challenges of Orange County’s stroke care system
Orange County system created to improve emergency stroke care takes patients to the hospitals most prepared to treat stroke. UC Irvine stroke neurologist Steven Cramer, MD, analyzes success.
The number of Orange County residents who get the highest level of care for stroke symptoms has increased to 20 percent since the adoption of a countywide stroke-neurology receiving center system in 2009, according to a study published in the April edition of the American Heart Association journal Stroke. The article is available online now.
“One in five patients who suffered an ischemic stroke were given the clot-busting drug tPA in time to reverse or reduce the stroke’s effects,” said lead author Dr. Steven C. Cramer, a UC Irvine stroke neurologist. Nationally, only 3 to 5 percent of patients receive tPA in time, he noted. Ischemic stroke, in which part of the brain is deprived of oxygen due to a blood clot and dies, is the most common form of the condition. Stroke is the third-leading cause of death in the U.S. and is among the primary causes of disability among Americans.
Under Orange County’s system, paramedics and ambulances take patients with acute stroke symptoms to one of nine stroke “hub” hospitals – receiving centers that offer sophisticated neurovascular care and have specialists available 24/7. Sixteen other hospitals, or “spokes,” send their stroke cases to these hubs.
“This marks an enormous improvement in the level of stroke care for Orange County residents,” said Cramer, who was honored by the county in 2009 for spearheading the system’s creation. “People who have had strokes are now walking out of hospitals. Hundreds are alive or have significantly better quality of life than they would have had before.”
The Stroke article – co-authored by Dr. Samuel J. Stratton, medical director of Orange County Emergency Medical Services, and colleagues in the county’s other receiving centers – analyzes 1,360 cases from the system’s first year.
“Orange County is fortunate to have the nation’s first countywide comprehensive stroke center system that provides leading neuro-intervention and primary care to all victims of this condition,” Stratton said. The system also serves as a model for other counties wishing to establish such a network.
A key component is ensuring access to hospitals with neuro-interventional radiologists who can remove a clot by threading a special catheter through a leg artery and into the brain. In 2009, the county had four hospitals with such around-the-clock capability, including UC Irvine. Today six receive patients from spoke hospitals.
Despite the early success, challenges remain, Cramer said: “The study shows that older adults and Hispanics are not reaping the benefits of this system to the same extent. They were less likely than other residents to receive high-level stroke care.”
He said it’s possible that these groups don’t recognize the symptoms quickly enough to benefit from timely care. Cramer and Stratton said the county has worked to improve awareness of stroke care and that rates among these groups have increased since 2009.
About UC Irvine Medical Center: Orange County’s only university hospital, UC Irvine Medical Center offers acute- and general-care services at its new, 482,000-square-foot UC Irvine Douglas Hospital and is home to the county’s only Level I trauma center, American College of Surgeons-verified regional burn center and National Cancer Institute-designated comprehensive cancer center. U.S. News & World Report has included UC Irvine for 11 consecutive years on its list of America’s Best Hospitals, giving special recognition to its urology, gynecology, kidney disorders and cancer programs.
About the University of California, Irvine: Founded in 1965, UCI is a top-ranked university dedicated to research, scholarship and community service. Led by Chancellor Michael Drake since 2005, UCI is among the most dynamic campuses in the University of California system, with nearly 28,000 undergraduate and graduate students, 1,100 faculty and 9,000 staff. Orange County’s second-largest employer, UCI contributes an annual economic impact of $4 billion. For more UCI news, visit www.today.uci.edu.
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