Research
Theme II: Optimizing Acute Stroke Care
Stroke is Treatable
In the past few years, major advances have been achieved in stroke treatment. The Canadian Stroke Network aims to optimize stroke care so that all patients have access to the full range of appropriate treatments. A unique characteristic of stroke, compared to other brain conditions, is that within certain time constraints it is treatable. If a patient recognizes what is happening as a stroke, rapidly gets to an emergency room (ER), and this particular ER gives the patient priority access to a CT scan, and the scan does not show any haemorrhage in the brain, and t-PA is started within 3 hours from the onset of symptoms, the patient’s deficit is much reduced, and sometimes totally eliminated.
What percentage of stroke patients receive t-PA? Our research shows that only about 7% of eligible patients get the drug. Why? Do they not recognize the symptoms? Can they not find adequate transportation to an ER? Do they end up in an ER that is unprepared to treat them? What happens to the patients after they enter hospital? Do they go to a specialized ward, or to a general medicine ward? Are they admitted at all? If they are, do they get adequate nursing care? Adequate physiotherapy? What percentage is back at work within 6 months? These and other unanswered questions are the reasons the CSN has set up the Registry of the Canadian Stroke Network, where data on stroke patients are being collected in small and large hospitals across the country. The information is then anonymized and centralized at the Institute for Clinical and Evaluative Science (ICES) for analysis.
Registry of the Canadian Stroke Network, Phase 4
Project leaders:
Moira Kapral, University of Toronto
Frank Silver, University of Toronto
Project Team:
Annette Robertson, Institute for Clinical and Evaluative Studies (ICES)
Susanna Tam, ICES
Jiming Fang, ICES
Ruth Hall, ICES
Bruce Haan, Millcreek Technology Group
Jack Tu, University of Toronto
Stephen Phillips, Dalhousie University
Michael Hill, University of Calgary
Kevin Willis, Canadian Stroke Network
Patrice Lindsay, Canadian Stroke Network
Project Summary:
The Registry of the Canadian Stroke Network (RCSN) is a clinical database characterizing the demographics, stroke type, severity, process of care, hospital treatments, complications and outcomes of patients with stroke or transient ischemic attack (TIA) seen at participating Canadian hospitals.
First launched in 2001, the RCSN has evolved into a large CSN project for collecting standardized high quality clinical data related to stroke care at three levels: 1) RCSN Regional Centre Database – data on stroke patients managed at Regional Designated Stroke Centres; 2) RCSN Stroke Provincial Audit Database – data on a random sample of all stroke patients managed at acute care hospitals in a given province; and 3) RCSN SPIRIT Database – data based on determining performance indicators entered by participating hospitals on their acute stroke patients (SPIRIT Acute) and their stroke prevention clinics (SPIRIT Secondary Prevention).
Data collected serve two key purposes: to provide a rich clinical database that is accessible to investigators for research projects, and to provide a mechanism for standardized and consistent measurement and monitoring of the quality of stroke care delivery on an ongoing basis at participating institutions, health care regions and at a provincial level.
For the RCSN Regional Database and the RCSN Provincial Audits, the data is collected by trained research nurses by reviewing hospital charts and entering the data onto laptop computers using custom RCSN data-entry software. The RCSN SPIRIT Database was designed to allow any hospital or clinic to enter a specific data on their stroke patients using a Web-based data entry tool. Hospitals are then provided, in real time, performance indicators of “best care” so that they can evaluate the quality of the care they are providing. Pooled data from other participating hospitals allows individual sites to compare their performance with other hospitals or provincial averages.
The RCSN has provided data for the evaluation of provincial stroke strategies so that health providers and policymakers can improve the quality of care. In Ontario, these reports demonstrate that stroke care is improving but there are still disparities between hospitals that need to be addressed. RCSN data has been used by investigators to publish research papers on stroke care, prognostic indicators and the impact of stroke treatments including the “clot busting” drug tPA and blood thinners.
Download the RCSN Factsheet