2021
Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention
Xian Y, Xu H, Smith E, Saver J, Reeves M, Bhatt D, Hernandez A, Peterson E, Schwamm L, Fonarow G. Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention. Stroke 2021, 53: 1328-1338. PMID: 34802250, DOI: 10.1161/strokeaha.121.035853.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeProportion of patientsIschemic strokeNeedle timeSymptom onsetClinical outcomesNationwide quality improvement initiativePhase IBenefits of tPAGuidelines-Stroke hospitalsMedian DTN timeSecond intervention periodStroke symptom onsetQuality improvement interventionsQuality improvement initiativesPhase IIQuality Improvement ProgramHigh rateMinutes preinterventionBleeding complicationsHospital mortalityDTN timeHospital arrivalTPA useTherapy start
2017
Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network
Moreno A, Schwamm L, Siddiqui K, Viswanathan A, Whitney C, Rost N, Zachrison K. Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network. Telemedicine Journal And E-Health 2017, 24: 678-683. PMID: 29271703, PMCID: PMC6014912, DOI: 10.1089/tmj.2017.0252.Peer-Reviewed Original ResearchConceptsDTN timePatient presentationTelestroke consultsTelestroke networkPatient-level regression analysesAcute ischemic stroke patientsShorter DTN timesIschemic stroke patientsFrequent contactPrimary predictor variableMedian DTNTPA administrationNeedle timeTPA useSpoke hospitalsStroke patientsMore frequent contactsHub hospitalImproved outcomesMedian numberTPA deliveryPatientsHospitalRegression analysisTelestrokeCoexistent Sickle Cell Disease Has No Impact on the Safety or Outcome of Lytic Therapy in Acute Ischemic Stroke
Adams R, Cox M, Ozark S, Kanter J, Schulte P, Xian Y, Fonarow G, Smith E, Schwamm L. Coexistent Sickle Cell Disease Has No Impact on the Safety or Outcome of Lytic Therapy in Acute Ischemic Stroke. Stroke 2017, 48: 686-691. PMID: 28183857, DOI: 10.1161/strokeaha.116.015412.Peer-Reviewed Original ResearchConceptsSickle cell diseaseAcute ischemic strokeIschemic strokeThrombolytic therapyCell diseaseMultivariable logistic regression modelAdmission National InstitutesGuidelines-Stroke registrySymptomatic intracranial hemorrhageHealth Stroke ScaleIntracranial hemorrhage rateAmerican Stroke AssociationAmerican Heart AssociationNational Heart LungNational InstituteLogistic regression modelsLytic therapyStroke ScaleTPA useBlood pressureDischarge outcomesHemorrhage rateStroke patientsBlood InstituteExchange transfusion
2016
Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age
Arora R, Salamon E, Katz J, Cox M, Saver J, Bhatt D, Fonarow G, Peterson E, Smith E, Schwamm L, Xian Y, Libman R. Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age. Stroke 2016, 47: 2347-2354. PMID: 27491734, DOI: 10.1161/strokeaha.116.012241.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdolescentAdultAge FactorsAgedAged, 80 and overBrain IschemiaFemaleFibrinolytic AgentsHospital MortalityHumansIntracranial HemorrhagesMaleMiddle AgedPractice Patterns, Physicians'PrognosisRegistriesRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeYoung AdultConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorAcute ischemic strokeSymptomatic hemorrhageTPA useIschemic strokeYounger patientsFunctional outcomeQuality improvement registryGood functional outcomeYears of ageYounger age groupsIntravenous thrombolysisHospital mortalityFibrinolytic therapyAcute rehabilitationIndependent ambulationDischarge outcomesMultivariable analysisHospice dischargePatientsAge groupsHemorrhagePlasminogen activatorMortality
2015
Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke
Sheth KN, Smith EE, Grau-Sepulveda MV, Kleindorfer D, Fonarow GC, Schwamm LH. Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke. Stroke 2015, 46: 732-739. PMID: 25672784, DOI: 10.1161/strokeaha.114.007506.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorSymptomatic intracranial hemorrhageTPA useAcute strokeIschemic strokeIntracranial hemorrhageHealth Stroke Scale scoreReal-world practice patternsGuidelines-Stroke programStroke Scale scoreAcute ischemic strokeCharacteristics of patientsLower National InstitutesPatient selection biasConventional thrombolysisHospital mortalityHospital outcomesSymptom onsetInterhospital transferThrombolytic therapyHospital characteristicsPractice patternsShip paradigmMAIN OUTCOME
2013
Temporal Trends in Patient Characteristics and Treatment With Intravenous Thrombolysis Among Acute Ischemic Stroke Patients at Get With the Guidelines–Stroke Hospitals
Schwamm L, Ali S, Reeves M, Smith E, Saver J, Messe S, Bhatt D, Grau-Sepulveda M, Peterson E, Fonarow G. Temporal Trends in Patient Characteristics and Treatment With Intravenous Thrombolysis Among Acute Ischemic Stroke Patients at Get With the Guidelines–Stroke Hospitals. Circulation Cardiovascular Quality And Outcomes 2013, 6: 543-549. DOI: 10.1161/circoutcomes.111.000095.Peer-Reviewed Original ResearchAcute ischemic stroke patientsIschemic stroke patientsTPA useAIS patientsPatient characteristicsStroke patientsHospitalized acute ischemic stroke patientsIntravenous tissue plasminogen activator useTissue plasminogen activator useNonwhite race/ethnicityAdditional calendar yearGuidelines-Stroke hospitalsAmerican Heart AssociationRace/ethnicityAIS admissionsGuidelines-StrokeEligible patientsIntravenous thrombolysisIntravenous tPAMore patientsMultivariable analysisHeart AssociationMild strokeTPA timeUnivariate analysisTemporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at Get With The Guidelines-Stroke hospitals.
Schwamm L, Ali S, Reeves M, Smith E, Saver J, Messe S, Bhatt D, Grau-Sepulveda M, Peterson E, Fonarow G. Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at Get With The Guidelines-Stroke hospitals. Circulation Cardiovascular Quality And Outcomes 2013, 6: 543-9. PMID: 24046398, DOI: 10.1161/circoutcomes.111.000303.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAge FactorsAgedAged, 80 and overAmerican Heart AssociationBrain IschemiaChi-Square DistributionFemaleFibrinolytic AgentsHospitalsHumansMaleMiddle AgedMultivariate AnalysisOdds RatioQuality Indicators, Health CareRegistriesRisk FactorsStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsIschemic stroke patientsTPA useAIS patientsPatient characteristicsStroke patientsHospitalized acute ischemic stroke patientsIntravenous tissue plasminogen activator useTissue plasminogen activator useNonwhite race/ethnicityAdditional calendar yearGuidelines-Stroke hospitalsAmerican Heart AssociationRace/ethnicityAIS admissionsGuidelines-StrokeEligible patientsIntravenous thrombolysisIntravenous tPAMore patientsMultivariable analysisHeart AssociationMild strokeTPA timeUnivariate analysis
2012
Emergency Medical Service Hospital Prenotification Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke
Lin C, Peterson E, Smith E, Saver J, Liang L, Xian Y, Olson D, Shah B, Hernandez A, Schwamm L, Fonarow G. Emergency Medical Service Hospital Prenotification Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2012, 5: 514-522. PMID: 22787065, DOI: 10.1161/circoutcomes.112.965210.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCommunicationEmergency Medical ServicesEmergency Service, HospitalFemaleFibrinolytic AgentsGuideline AdherenceHealth Services AccessibilityHospitalsHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOutcome and Process Assessment, Health CarePractice Guidelines as TopicQuality ImprovementRegistriesStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic strokeTissue plasminogen activatorNeedle timeEMS prenotificationHospital prenotificationIschemic strokeEligible patientsShorter doorIntravenous tissue plasminogen activatorClustering of patientsShorter symptom onsetQuality of careGuidelines-StrokeTPA useSymptom onsetPotential strokeStroke treatmentPatientsPoisson regressionStrokeTreatment ratesIncoming patientsGreater likelihoodPrenotificationMinutesPredictors of Increased Intravenous Tissue Plasminogen Activator Use Among Hospitals Participating in the Massachusetts Primary Stroke Service Program
Rost N, Smith E, Pervez M, Mello P, Dreyer P, Schwamm L. Predictors of Increased Intravenous Tissue Plasminogen Activator Use Among Hospitals Participating in the Massachusetts Primary Stroke Service Program. Circulation Cardiovascular Quality And Outcomes 2012, 5: 314-320. PMID: 22534407, PMCID: PMC3361890, DOI: 10.1161/circoutcomes.111.962829.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overEmergency Service, HospitalFemaleFibrinolytic AgentsHealthcare DisparitiesHumansInfusions, IntravenousLinear ModelsLogistic ModelsMaleMassachusettsMiddle AgedMultivariate AnalysisOdds RatioPatient SelectionPractice Guidelines as TopicQuality ImprovementRegional Medical ProgramsRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeConceptsIntravenous tissue plasminogen activator useTissue plasminogen activator useAcute ischemic strokeTPA useIschemic strokeOlder acute ischemic stroke patientsAcute ischemic stroke patientsGuidelines-Stroke programStroke center designationIschemic stroke patientsRate of thrombolysisQuality improvement initiativesEmergency medical servicesStroke onsetSymptom onsetStroke patientsTreatment disparitiesCenter designationPatientsHospitalMassachusetts DepartmentImprovement initiativesMedical servicesOverall rateFurther studies
2008
Advance Hospital Notification by EMS in Acute Stroke Is Associated with Shorter Door-to-Computed Tomography Time andIncreased Likelihood of Administration of Tissue-Plasminogen Activator
Abdullah A, Smith E, Biddinger P, Kalenderian D, Schwamm L. Advance Hospital Notification by EMS in Acute Stroke Is Associated with Shorter Door-to-Computed Tomography Time andIncreased Likelihood of Administration of Tissue-Plasminogen Activator. Prehospital Emergency Care 2008, 12: 426-431. PMID: 18924004, DOI: 10.1080/10903120802290828.Peer-Reviewed Original ResearchConceptsEmergency medical servicesTissue plasminogen activatorAcute stroke patientsStroke patientsTertiary care stroke centerIntravenous tissue plasminogen activatorCatheter-based thrombolysisED arrival timeHospital time intervalsIntra-arterial thrombolysisMedian National InstitutesHealth Stroke ScaleUse of thrombolysisEmergency department arrivalTerms of ageHigher baseline ratesPrior strokeTPA useAcute strokeStroke centersStroke ScaleSymptom onsetStroke databaseMild strokeHospital notification