Data Report

By Author: Sherry Roberts
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Stroke is ranked as the fifth leading cause of mortality in the USA. A large proportion (87%) of all strokes is ischemic strokes while transient attacks cause similar symptoms. However, approximately 30% of people who have transient ischemic attacks often have a stroke within one year. ). The survey presents recent trends in visits to emergency departments for ischemic stroke. The role of the emergency department in the diagnosis and management of ischemic stroke cannot be overstated. Monitoring national visits to the emergency department is critical in assessing the impact of the numerous national-wide campaigns to promote the emergency care of stroke and other life-threatening conditions. In addition, the regular monitoring enables the assessment of the disease burden to the national health system. The evaluation of ischemic stroke and transient ischemic attacks in the department is similar, as such, the report combines the two in the analysis.
The data is derived from the National Hospital Ambulatory Medical Care Survey 2001-2011 (NAMCS). NAMCS is a national survey that provides objective and reliable information about ...
... the provision and the use of ambulatory medical services in the USA. The findings of the survey are based on national visits to non-federal employed office-based physicians engaged in direct patient care. The survey collects data on the utilization and provision of health care services in hospital emergency and outpatient departments.
The sampling framework for the 2011 survey was constructed SDI’s “Healthcare Market Index” and “Hospital Market Profiling Solution. The survey used a multistage probability design with samples from primary sampling units, hospitals with primary sampling units and patient visits to emergency areas. The data was collected by the U.S Bureau of Census and hospital staff or Census field representatives completed the questionnaire for the sample. The SRA International, Inc., Durham did the data processing and coding. The data was analyzed and evaluated using the statistical packages SAS version 9.3 and State Version 12.0. A weighted least-square regression analysis was used to report the significance of trends at the level of 0.05. The differences between rates of change in every trend and between subgroups were evaluated for tow-tailed t tests and a significance of level 0.05.
Descriptive statistic
In the ten years period under study, there were approximately 2.3 million emergency department visits due to ischemic stroke. However, the total ischemic stroke-related ambulatory visits were approximately 9.5 million. The majority of these visits (71.1%) occurred in a physician visits. The average annual visits per 100 individuals were 42.8. The bar graph below indicates the overall trend in ischemic stroke visits.
According to the graph, there was a steady increase in ischemic stroke visits in the first three years (2000-03). However, there was a notable increase in the number of ischemic stroke visits between 2004 and 2005. In the following years, ischemic stroke visits stabilized. The distribution of ischemic visits in terms of setting is depicted below.
Majority of the visits were in physician office (69.4%) with only a small percentage being outpatient departments. Females have an all time high number of visits as shown below.

For the ten years under study, it is only between 2006 and 2007 that men constituted the largest number of ischemic stroke-related visits.
19% of these visits were by persons under 15 years while the majority of the visits were by individuals between 25 and 44 years (27.9%) and those between 45 and 64 years (21.5%). In terms of gender, women constituted the largest number of emergency visits (55.1%). The participants also exhibited a wide variation in terms of race. 75 % of those admitted in the emergency units were whites while 21.4% were blacks.

Over the ten years of the study, there was a general decrease in ischemic stroke emergency department visits regardless of age. The rate of persons above 18 years, who visited the emergency department for ischemic visits decreased by 35%. Similarly, ischemic emergency visits by individuals between 55-74 years decreased by 51% while those above 75 decreased 26%. There was a positive correlation between the age of the patients and emergency department visit. As age progresses, the chance of emergency visits through an ambulance increases.

The survey also assessed the number of number of ischemic emergency department visits in which patients arrived by ambulances. It is recommended that suspected stroke victims be transported without delay to the nearest health facility with a stroke unit that can offer ultra-early treatment. As such, they use of ambulances to transport individuals suspected of ischemic stroke is important. According to the study, there was a general decline (41%) of older patients who visited emergency departments by ambulances for ischemic stroke. However, the majority of older people, above 75 years arrived by ambulance. However, fewer young people were arriving with ambulances for ischemic stroke. The table below indicates trends in ambulance visits
Various stakeholders including the Stroke Council of the American Heart Association have established guidelines for the management of patients with ischemic stroke. The guidelines establish diagnosis and treatment protocols that should be initiated once a patient is received in the emergency department. Some of the common diagnosis procedures include MRI and CT test. As such, the study explored the percentage of emergency visits with MRI or CT test ordered. Statistics from the study indicates that the number of ischemic stroke emergency visits that required MRI or CT test increased 39% within the ten years. The imaging usage increased faster for ischemic stroke those other diagnoses.
Not all ischemic emergency department visits result in admission. Some visits may result in discharge while others may result in a transfer to other hospitals. Understanding the fate of ischemic stroke once they arrive at the emergency department is essential. The national statistics indicate that the number of individuals admitted for ischemic stroke increased from 71% to 78% in 2011. This indicates a large number of individuals who visit the emergency department due to ischemic stroke end up being admitted for further management.

Conclusion
Although stroke ranks among the leading cause of mortality in the USA, mortality from has been declining. The national survey indicates that there has been an overall decrease in emergency visits particularly for individuals above 55 years. However, persons above 75 years were of the greatest risks of the emergency visit. Ischemic stroke un-proportionally affects the old and a very small percentage o the young people. Incidences of ischemic stroke or TIA are 1% among children under one year. The national survey indicates ischemic stroke and TIA continue to be the huge burden to the national health system. The average annual visits continue to be high with the demanding diagnosis and treatment therapies cost health institutions a lot of resources. The high number of aged persons visiting the emergency department indicates a general trend in the health facility. Most of the long-term care facilities constitute a large number of the elderly. Advancement in ischemic stroke diagnosis and treatment technology has resulted in a large number of individuals being admitted. The use of MRI imaging and CT tests has also increased thus improving the management of the disease. The study also indicates changes in the resources utilized in the management of ischemic stroke and TIA. The use of advanced imaging and admission to hospital has increased as more diagnosis and management alternatives emergence. The continued monitoring of these trends is essential in evaluating the individual burden each condition impacts on the entire health system. It indicates critical trends that can be used to guide the allocation of resources. In addition, it provides information on the effectiveness of the numerous prevention and health promotion interventions.
References
Trends in Emergency Department Visits for Ischemic Stroke and Transient Ischemic Attack: United States, 2001–201.

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