Comprehensive Stroke Measure

The graph below displays the percentage of eligible patients diagnosed with stroke receiving all of the comprehensive stroke care measures.

Chart.

Source: Midas TJC Comprehensive Stroke Profile

Timely and Effective Comprehensive Care for Stroke Patients Explanation of Care
Percent of eligible patients for whom a NIHSS score performed prior to any acute recanalization A neurological examination of all patients presenting to the hospital emergency department with warning signs and symptoms of stroke should be a top priority and performed in a timely fashion. Use of a standardized stroke scale or scoring tool ensures that the major components of the neurological examination are evaluated. Scores obtained aid in the initial diagnosis of the patient, facilitate communication among healthcare professionals, and identify patient eligibility for various interventions and the potential for complications.
Percent of eligible patients for whom a severity measurement is performed prior to surgical intervention Subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) are medical emergencies requiring rapid diagnosis and assessment. The severity of SAHs should be documented with the Hunt and Hess Scale, and the severity of ICHs should be documented with ICH score to capture the clinical state of the patient, because it is a useful predictor of outcome and helpful in planning future care with family and physicians.
Percent of eligible patients who are treated with a procoagulant reversal agent Patients receiving oral anticoagulants, as well as those with an acquired or congenital coagulopathy, are at increased risk for ICH and hemorrhagic expansion with warfarin associated bleeds. Prompt international normalized ratio (INR) reversal with intravenous infusions of vitamin K and fresh-frozen plasma or normalization with prothrombin complex concentrates are recommended because several studies have shown that these agents can rapidly normalize the INR within minutes
Percent of ischemic stroke patients who develop a symptomatic intracranial hemorrhage ≤ 36 hours after the onset of treatment with endovascular reperfusion therapy Endovascular reperfusion therapy in acute ischemic stroke comprises a number of pharmacological and mechanical procedures. Mechanical endovascular thrombectomy (a treatment option for patients with large vessel occlusions in whom pharmacological thrombolysis is contraindicated or might be ineffective) is intended to improve tissue rescue and diminish reperfusion hemorrhage while broadening the population eligible for therapy. This procedure may be performed alone or in conjunction with IV or IA t-PA.
Percent of eligible patients for whom nimodipine treatment was administered within 24 hours of hospital arrival Cerebral vasospasm is a serious complication following SAH. Constriction of the arterial lumen results in diminished cerebral perfusion distal to the affected artery, which produces a delayed neurological deficit that may progress to cerebral infarction without early management. The main goal of current treatment is to prevent or limit the severity of cerebral vasospasm.
Percent of ischemic stroke patients treated with intra-venous (IV) or intra-arterial (IA) thrombolytic therapy (t-PA) or mechanical endovascular reperfusion therapy and have an mRS less than or equal to 2 at 90 days The Modified Rankin Scale (mRS) is the accepted standard for assessing recovery post-stroke. Scores are used to measure the degree of disability or dependence in activities of daily living. Score reliability and reproducibility are improved through use of a structured interview by a trained evaluator. Interviews may be conducted in-person or over the phone.
Percent of ischemic stroke patients who receive mechanical endovascular reperfusion (MER) therapy and achieve TICI 2B or higher within 120 minutes of hospital arrival. The Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade is used to measure cerebral reperfusion and should be achieved as early as possible, and within 6 hours of stroke onset. Reduced time from symptom onset to reperfusion with MER therapy is highly associated with better clinical outcomes.
Percent of ischemic stroke patients who receive mechanical endovascular reperfusion therapy and achieve TICI 2B or higher within 60 minutes from the time of skin puncture Reperfusion should be achieved as early as possible, and within 6 hours of stroke onset. Reduced time from symptom onset to reperfusion with MER therapy is highly associated with better clinical outcomes.
Comprehensive Stroke All-or-None Bundle The Comprehensive Stroke Bundle is a pass-fail measure at the individual patient level that asks whether an eligible patient has received all of the best practice comprehensive care treatment for stroke.