2023
Performance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report From the Get With The Guidelines–Stroke Registry
Raychev R, Sun J, Schwamm L, Smith E, Fonarow G, Messé S, Xian Y, Chiswell K, Blanco R, Mac Grory B, Saver J. Performance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report From the Get With The Guidelines–Stroke Registry. Circulation 2023, 148: 2019-2028. PMID: 37855118, DOI: 10.1161/circulationaha.123.066114.Peer-Reviewed Original ResearchConceptsComprehensive stroke centerPrimary stroke centerThrombectomy-capable stroke centersAcute ischemic strokeGuidelines-Stroke registryEndovascular thrombectomyStroke centersReperfusion therapyIschemic strokeClinical outcomesHealth Stroke Scale scoreClinical efficacy outcomesStroke Scale scoreHigher National InstitutesOdds of dischargeGoal doorEVT proceduresHospital mortalityIntravenous thrombolysisEfficacy outcomesSuccessful reperfusionCohort studyDischarge destinationNeedle timePuncture timeInsurance-Based Disparities in Stroke Center Access in California: A Network Science Approach
Zachrison K, Hsia R, Schwamm L, Yan Z, Samuels-Kalow M, Reeves M, Camargo C, Onnela J. Insurance-Based Disparities in Stroke Center Access in California: A Network Science Approach. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009868. PMID: 37746725, PMCID: PMC10592016, DOI: 10.1161/circoutcomes.122.009868.Peer-Reviewed Original ResearchConceptsInsurance-based disparitiesStroke centersEmergency departmentHospital clustersInitial emergency departmentIschemic stroke admissionsHospital emergency departmentClusters of hospitalsLogistic regression modelsStroke admissionsUninsured patientsPatient insuranceLower oddsPatientsLess strokeCenter accessOddsCenter transferHospitalLikelihood of transferInsurance groupsRegression modelsLower proportionDepartmentAssociationOutcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology
Pedreira B, Zachrison K, Singhal A, Yan Z, Oliveira-Filho J, Schwamm L. Outcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology. Arquivos De Neuro-Psiquiatria 2023, 81: 616-623. PMID: 37336506, PMCID: PMC10371407, DOI: 10.1055/s-0043-1769124.Peer-Reviewed Original ResearchConceptsUndetermined stroke etiologyAtrial fibrillationRecurrent strokeStroke etiologyAF patientsFavorable outcomeAcademic comprehensive stroke centerHealth Stroke Scale scoreMedian National InstitutesSingle-center sampleComprehensive stroke centerRecurrent ischemic strokeStroke Scale scoreHistory of strokePotent risk factorDifferent treatment strategiesHospital mortalitySecondary prophylaxisReperfusion therapyCardioembolic strokeIschemic strokeStroke centersDischarge outcomesRisk factorsTreatment strategies
2022
Differences in Performance on Quality Measures for Thrombectomy‐Capable Stroke Centers Compared With Comprehensive Stroke Centers in 2019 to 2020
Baker D, Schmaltz S, Kolbusz K, Messé S, Jauch E, Schwamm L. Differences in Performance on Quality Measures for Thrombectomy‐Capable Stroke Centers Compared With Comprehensive Stroke Centers in 2019 to 2020. Stroke Vascular And Interventional Neurology 2022, 2 DOI: 10.1161/svin.121.000302.Peer-Reviewed Original ResearchComprehensive stroke centerLarge vessel occlusionMechanical thrombectomyStroke centersSkin punctureCerebral infarctionMedian timeStroke center certificationSymptomatic hemorrhagic complicationsSymptomatic hemorrhagic transformationPercentage of patientsProportion of patientsSuccessful mechanical thrombectomyThrombectomy-capable stroke centersProlonged transport timesWilcoxon rank sum testRank sum testHemorrhagic transformationHemorrhagic complicationsStroke careCenter certificationSigned-rank testCurrent recommendationsPatientsMedian proportionRationale and design of a stepped wedge cluster randomised trial to improve acute reperfusion treatment quality for stroke: IMPROVE stroke care in China
Li Z, Wang C, Zhang X, Zong L, Zhou H, Gu H, Jiang Y, Pan Y, Meng X, Zhou Q, Zhao H, Yang X, Wang M, Xiong Y, Zhao X, Wang Y, Liu L, Ma X, Morgan L, Xian Y, Schwamm L, Wang Y. Rationale and design of a stepped wedge cluster randomised trial to improve acute reperfusion treatment quality for stroke: IMPROVE stroke care in China. Stroke And Vascular Neurology 2022, 7: 451-456. PMID: 35354662, PMCID: PMC9614172, DOI: 10.1136/svn-2021-001461.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIntravenous thrombolysisReperfusion therapyEndovascular thrombectomyEligible patientsPrimary outcomeWedge clusterQuality improvement interventionsMixed-effects logistic regressionTreatment qualityIntraclass correlation coefficientReperfusion treatmentHospital delayIschemic strokeStroke centersTreat principleStroke careEfficacy analysisChina trialEffective treatmentNumber of casesImprovement interventionsPatientsComprehensive interventionLogistic regressionThe relationship between stroke system organization and disparities in access to stroke center care in California
Zachrison K, Samuels‐Kalow M, Li S, Yan Z, Reeves M, Hsia R, Schwamm L, Camargo C. The relationship between stroke system organization and disparities in access to stroke center care in California. Journal Of The American College Of Emergency Physicians Open 2022, 3: e12706. PMID: 35316966, PMCID: PMC8921441, DOI: 10.1002/emp2.12706.Peer-Reviewed Original ResearchIschemic stroke patientsInterhospital transferStroke patientsReperfusion interventionsCenter careEthnic disparitiesAcute ischemic stroke patientsNon-Hispanic black patientsAsian/Pacific Islander patientsAcute ischemic strokeComprehensive stroke centerOdds of dischargeHospital-level characteristicsPacific Islander patientsNon-Hispanic Asian/Pacific IslandersNon-Hispanic blacksAsian/Pacific IslandersInterhospital patient transfersOutcomes of interestNon-Hispanic whitesHierarchical logistic regressionReperfusion therapyHospital dischargeIschemic strokeStroke centersRace-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke
Mendelson S, Zhang S, Matsouaka R, Xian Y, Shah S, Lytle B, Solomon N, Schwamm L, Smith E, Saver J, Fonarow G, Holl J, Prabhakaran S. Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke. Neurology 2022, 98: e1596-e1604. PMID: 35228335, PMCID: PMC9052571, DOI: 10.1212/wnl.0000000000200138.Peer-Reviewed Original ResearchConceptsTissue plasminogen activatorNon-Hispanic black patientsTPA-eligible patientsRace/ethnicityBlack patientsNon-Hispanic black race/ethnicityNon-Hispanic white patientsBlack race/ethnicityAsian race/ethnicityGuidelines-Stroke registryPrimary stroke centerSingle-center studyMultivariable logistic regressionRace-ethnic disparitiesNon-Hispanic whitesEligible patientsHospital factorsNationwide registryPatient demographicsStroke centersSymptom onsetWhite patientsMultivariable analysisStroke careAsian patients
2021
Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks
Zachrison K, Richard J, Wilcock A, Zubizaretta J, Schwamm L, Uscher-Pines L, Mehrotra A. Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks. JAMA Network Open 2021, 4: e2126612. PMID: 34554236, PMCID: PMC8461501, DOI: 10.1001/jamanetworkopen.2021.26612.Peer-Reviewed Original ResearchConceptsHospital stroke volumeControl hospitalsStroke volumeStroke centersStroke symptomsStroke systemsCase mixTransient ischemic attack admissionsHospital pairsInitial hospital presentationThrombectomy-capable hospitalsComprehensive stroke centerTransient ischemic attackPrimary stroke centerCross-sectional studyMajor teaching hospitalObserved patient characteristicsBed sizeHospital presentationIschemic attackInitial hospitalCritical access hospitalsPatient characteristicsInterhospital transferPostimplementation period
2020
Trends Among Rural and Urban Medicare Beneficiaries in Care Delivery and Outcomes for Acute Stroke and Transient Ischemic Attacks, 2008-2017
Wilcock A, Zachrison K, Schwamm L, Uscher-Pines L, Zubizarreta J, Mehrotra A. Trends Among Rural and Urban Medicare Beneficiaries in Care Delivery and Outcomes for Acute Stroke and Transient Ischemic Attacks, 2008-2017. JAMA Neurology 2020, 77: 863-871. PMID: 32364573, PMCID: PMC7358912, DOI: 10.1001/jamaneurol.2020.0770.Peer-Reviewed Original ResearchConceptsTransient ischemic attackAcute ischemic strokeIschemic attackAcute strokeStroke centersRural-urban disparitiesResidential zip codeIschemic strokeEnd-stage kidney diseaseRural-Urban Commuting Area codesDescriptive observational studyHealth care centersUrban Medicare beneficiariesQuality of careTraditional MedicareNeurologist evaluationOutcome patientsUrban patientsStroke careNeurology consultationKidney diseaseMean ageCare centerStroke systemsObservational study
2019
Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association
Adeoye O, Nyström K, Yavagal D, Luciano J, Nogueira R, Zorowitz R, Khalessi A, Bushnell C, Barsan W, Panagos P, Alberts M, Tiner A, Schwamm L, Jauch E. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association. Stroke 2019, 50: e187-e210. PMID: 31104615, DOI: 10.1161/str.0000000000000173.Peer-Reviewed Original ResearchConceptsAmerican Stroke AssociationStroke systemsStroke AssociationStroke center certificationMobile stroke unitEmergency medical servicesHospital dischargeSecondary preventionStroke centersEndovascular therapyStroke unitPrimary preventionCenter certificationNeurocritical careAssociation recommendationsCareBasis of improvementStroke recognitionMedical servicesHealthcare agenciesScientific evidenceHealthcare policyAppropriate facilitiesPreventionSignificant changesUse, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States
Shah S, Xian Y, Sheng S, Zachrison KS, Saver JL, Sheth KN, Fonarow GC, Schwamm LH, Smith EE. Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States. Circulation 2019, 139: 1568-1577. PMID: 30700144, PMCID: PMC6816244, DOI: 10.1161/circulationaha.118.036509.Peer-Reviewed Original ResearchConceptsEndovascular therapyInterhospital transferHospital outcomesIschemic strokeMultivariable logistic regression modelSymptomatic intracranial hemorrhageAcute ischemic strokeComprehensive stroke centerLarge vessel occlusionRisk-adjusted modelsLogistic regression modelsEVT outcomesGuidelines-StrokeHospital mortalityStroke centersIndependent ambulationPivotal trialsStroke careIntracranial hemorrhageVessel occlusionEVT casesStroke systemsWhite racePatientsFurther evaluationComponents and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals
Menon B, Xu H, Cox M, Saver J, Goyal M, Peterson E, Xian Y, Matsuoka R, Jehan R, Yavagal D, Gupta R, Mehta B, Bhatt D, Fonarow G, Schwamm L, Smith E. Components and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals. Circulation 2019, 139: 169-179. PMID: 30586703, DOI: 10.1161/circulationaha.118.036701.Peer-Reviewed Original ResearchConceptsGuidelines-Stroke hospitalsEndovascular therapyHospital-level variablesShorter doorArterial accessCase volumeFirst pass timeArterial puncture timeComprehensive stroke centerLarge vessel occlusionCalendar year quarterWorkflow timesSignificant linear time trendsIschemic strokeLonger doorMedian doorStroke centersArterial punctureDiabetes mellitusMultivariable analysisPuncture timeFaster doorEmergency departmentClinical trialsMultivariable modeling
2018
Rates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care
Ali S, Fonarow G, Liang L, Xian Y, Smith E, Bhatt D, Schwamm L. Rates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care. Circulation Cardiovascular Quality And Outcomes 2018, 11: e003359. PMID: 30354551, DOI: 10.1161/circoutcomes.116.003359.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCentralized Hospital ServicesDisability EvaluationFemaleHealthcare DisparitiesHospital MortalityHumansMaleMiddle AgedPatient AdmissionPatient TransferRecovery of FunctionRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsSpecialized stroke centersStroke centersHospital mortalityAIS casesPrevious stroke/transient ischemic attackStroke/transient ischemic attackHealth Stroke Scale scoreHigher median National InstitutesWorse short-term outcomesAcute ischemic stroke careGuidelines-Stroke registryMedian National InstitutesOutcomes of patientsStroke Scale scoreTransient ischemic attackShort-term outcomesIschemic stroke careTransfer of patientsMidwest teaching hospitalInstitutional mortality ratesIschemic attackMultivariable adjustmentBaseline characteristicsRankin ScaleClinical outcomesQuality of care for ischemic stroke in China vs India: Findings from national clinical registries.
Li Z, Pandian J, Sylaja P, Wang Y, Zhao X, Liu L, Wang C, Khurana D, Srivastava M, Kaul S, Arora D, Schwamm L, Wang Y, Singhal A. Quality of care for ischemic stroke in China vs India: Findings from national clinical registries. Neurology 2018, 91: e1348-e1354. PMID: 30158158, PMCID: PMC6177271, DOI: 10.1212/wnl.0000000000006291.Peer-Reviewed Original ResearchConceptsChina National Stroke Registry IIGreater stroke severityStroke risk factorsRisk factorsStroke severityClinical outcomesStroke careIndian patientsAcademic stroke centerNational clinical registryIschemic stroke patientsBurden of strokeIschemic stroke careDifferent risk factorsQuality of careHospital mortalityIschemic strokeStroke centersAcute managementStroke patientsStroke ProjectChinese patientsClinical registryWorse outcomesAcademic hospitalComparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States
Man S, Zhao X, Uchino K, Hussain M, Smith E, Bhatt D, Xian Y, Schwamm L, Shah S, Khan Y, Fonarow G. Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States. Circulation Cardiovascular Quality And Outcomes 2018, 11: e004512. PMID: 29794035, PMCID: PMC5978771, DOI: 10.1161/circoutcomes.117.004512.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCertificationComprehensive Health CareDelivery of Health Care, IntegratedEmergency Service, HospitalEndovascular ProceduresFemaleHospital MortalityHospitalsHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionPatient TransferQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsPrimary stroke centerEmergency department admissionsStroke center certificationAcute ischemic strokeIschemic stroke careStroke centersStroke careDepartment admissionsHospital mortalityHospital outcomesIntravenous tPAIschemic strokeCenter certificationTPA timeComprehensive Stroke Center (CSC) certificationAcute ischemic stroke careMultivariable logistic regression modelAcute reperfusion therapyAcute stroke triageBrain Attack CoalitionDefect-free careComprehensive stroke centerOverall care qualityLogistic regression modelsGuidelines-Stroke
2017
Clinical Imaging Factors Associated With Infarct Progression in Patients With Ischemic Stroke During Transfer for Mechanical Thrombectomy
Boulouis G, Lauer A, Siddiqui A, Charidimou A, Regenhardt R, Viswanathan A, Rost N, Leslie-Mazwi T, Schwamm L. Clinical Imaging Factors Associated With Infarct Progression in Patients With Ischemic Stroke During Transfer for Mechanical Thrombectomy. JAMA Neurology 2017, 74: 1361-1367. PMID: 28973081, PMCID: PMC5710581, DOI: 10.1001/jamaneurol.2017.2149.Peer-Reviewed Original ResearchConceptsThrombectomy-capable stroke centersCollateral blood flowIschemic strokeInfarct progressionMechanical thrombectomyCT angiographyMAIN OUTCOMEVessel statusBlood flowImaging factorsHigher adjusted odds ratioVascular imagingFavorable imaging profileHealth Stroke ScoreAcute ischemic strokeHigher National InstitutesAdjusted odds ratioRegional stroke networkStroke care networksStroke centersStroke ScoreConsecutive patientsStroke NetworkClinical severityFutile transfersImmediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to Nonthrombectomy Centers
Boulouis G, Siddiqui K, Lauer A, Charidimou A, Regenhardt R, Viswanathan A, Leslie-Mazwi T, Rost N, Schwamm L. Immediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to Nonthrombectomy Centers. Stroke 2017, 48: 2297-2300. PMID: 28687641, DOI: 10.1161/strokeaha.117.017607.Peer-Reviewed Original ResearchConceptsThrombectomy-capable stroke centersEndovascular thrombectomyVascular imagingCurrent guidelinesAlberta Stroke Program Early CT ScoreUnnecessary transfersHealth Stroke ScaleAcute ischemic strokeMain outcome variablesBaseline vascularStroke ScaleIschemic strokeStroke centersCT scoreFutile transfersPatientsEfficient triageHospitalYielded sensitivityOutcome variablesOptimal selection criteriaNational InstituteStrokeImagingOcclusion level
2015
Treatment and Outcome of Thrombolysis-Related Hemorrhage: A Multicenter Retrospective Study
Yaghi S, Boehme A, Dibu J, Guerrero C, Ali S, Martin-Schild S, Sands K, Noorian A, Blum C, Chaudhary S, Schwamm L, Liebeskind D, Marshall R, Willey J. Treatment and Outcome of Thrombolysis-Related Hemorrhage: A Multicenter Retrospective Study. JAMA Neurology 2015, 72: 1-7. PMID: 26501741, PMCID: PMC4845894, DOI: 10.1001/jamaneurol.2015.2371.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageRecombinant tissue plasminogen activatorMulticenter retrospective studyHematoma expansionHospital mortalityMedian timeRetrospective studyIntravenous recombinant tissue plasminogen activatorHealth Stroke Scale scoreParenchymal hematoma type 2Code status changeOutcome of thrombolysisStroke-Monitoring StudyComprehensive stroke centerHospital mortality rateOutcomes of patientsStroke Scale scoreTissue plasminogen activatorIschemic strokePrimary outcomeRtPA therapySecondary outcomesStroke centersSymptom onsetIntracerebral hemorrhageVariation and Trends in the Documentation of National Institutes of Health Stroke Scale in GWTG-Stroke Hospitals
Reeves M, Smith E, Fonarow G, Zhao X, Thompson M, Peterson E, Schwamm L, Olson D. Variation and Trends in the Documentation of National Institutes of Health Stroke Scale in GWTG-Stroke Hospitals. Circulation Cardiovascular Quality And Outcomes 2015, 8: s90-s98. PMID: 26515215, DOI: 10.1161/circoutcomes.115.001775.Peer-Reviewed Original ResearchConceptsGWTG-Stroke hospitalsHealth Stroke ScaleNIHSS scoreDocumentation ratesNIHSS dataStroke ScaleMultivariable logistic regression modelAcute ischemic strokeHospital-level factorsPrimary stroke centerImportant prognostic variablesPatient-level predictorsNational InstituteLogistic regression modelsMedian NIHSSIschemic strokeStroke centersThrombolysis candidatesClinical registryPrognostic variablesNIHSSHospitalPatientsStrokeLow documentationTelestroke
Rubin M, Demaerschalk B, Schwamm L, Wechsler L. Telestroke. 2015, 47-57. DOI: 10.1007/978-1-4939-2349-6_5.Peer-Reviewed Original ResearchSecondary preventionStroke careHealth Stroke Scale scoreMajor public health problemStroke Scale scoreAcute ischemic strokeAcute stroke carePrimary stroke centerAcute stroke evaluationPrevention of complicationsEducation of patientsPublic health problemPrehospital emergency medical systemEmergency medical systemExcellent interrater agreementStroke practiceStroke providersTelestroke modelIschemic strokeStroke centersStroke evaluationCerebrovascular diseaseEvidence-based practicePoststroke outcomesBedside assessment