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August 1, 2026SAGE Open MedicineOpen Access

Primary Stroke Center and ED co-location linked to a ~5% absolute increase in AIS IVT rates.

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Why the study?

It was unknown whether co-location of a Primary Stroke Center and an Emergency Department was associated with higher intravenous thrombolysis rates after aligning emergency admission pathways.

Does co-location of a Primary Stroke Center and an Emergency Department improve intravenous thrombolysis rates in patients with acute ischemic stroke?

Population

1,950 patients with suspected stroke (914 with acute ischemic stroke)

Comparison

After co-location vs before co-location of a Primary Stroke Center and Emergency Department

Design

Retrospective before-and-after cohort study

Key result

Co-location of a Primary Stroke Center and Emergency Department was associated with a 4.6 percentage point increase (95% CI 0.1-9.1) in IVT rates among patients with acute ischemic stroke.

Authors

MGMartin Faurholdt GudeTBThomas BasseAJArne Sylvester Rønde Jensen

Discussion

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Overview

Co-location of PSC and ED was associated with higher IVT rates; hypothesis-generating and should not yet change practice.

Key Points

  • To evaluate whether co-locating a primary stroke center and an emergency department associates with increased rates of intravenous thrombolysis in acute ischemic stroke.
  • Retrospective before-and-after cohort study in Denmark comparing two 6-month intervals before (July–December 2021) and after (July–December 2022) a hospital merger and co-location.
  • Included 1,950 patients with suspected stroke (1,059 before, 891 after) using Danish Stroke Center Database records linked with prehospital emergency data.
  • Estimated absolute risk differences using linear regression with robust variance estimation and adjusted via inverse probability weighting.
  • Among 914 patients with acute ischemic stroke, the intravenous thrombolysis rate increased by 4.6 percentage points (95% CI 0.1–9.1), rising from 12.2% (95% CI 9.2–15.2) before co-location.
  • In emergency medical services-transported patients following emergency calls, the thrombolysis rate increased by 10.2 percentage points (95% CI 0.5–19.9), while median door-to-needle time rose from 26.5 to 40.0 minutes (p=0.003).
  • Hospital admissions for stroke mimics decreased from 26.3% before co-location to 17.9% after co-location.

Study Design

Type

Cohort (n=1,950)

Multicenter

Yes

Structured PICO

Does co-location of a Primary Stroke Center and an Emergency Department improve intravenous thrombolysis rates in patients with acute ischemic stroke?

P
Population
1,950 patients with suspected stroke (914 with acute ischemic stroke) evaluated during two 6-month periods before and after hospital co-location.
E
Exposure
Co-location of a Primary Stroke Center (PSC) and an Emergency Department (ED) following a hospital merger (July 1 to December 31, 2022)
C
Comparator
Before co-location (July 1 to December 31, 2021)
O
Outcome
Proportion of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT)

Main Result

Effect estimate: Absolute risk difference 4.6 percentage points (95% CI 0.1-9.1)

Absolute Event Rate: 16.8% vs 12.2%

Co-location of a Primary Stroke Center and an Emergency Department was associated with significantly higher intravenous thrombolysis rates for acute ischemic stroke, despite an increase in door-to-needle times for EMS-transported patients.

Cite This Study

Gude et al. (2026) conducted a cohort in Acute ischemic stroke (n=1,950). Co-location of Primary Stroke Center and Emergency Department vs. Before co-location was evaluated on Proportion of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) (Absolute risk difference 4.6 percentage points, 95% CI 0.1-9.1). Co-location of a Primary Stroke Center and Emergency Department was associated with a 4.6 percentage point increase (95% CI 0.1-9.1) in IVT rates among patients with acute ischemic stroke.

synapsesocial.com/papers/6a826ebf004fcf503374b060https://doi.org/10.1177/20503121261477313
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Abstract TP037: Reducing Door-to-Needle Times in the Emergency Department Through Optimized Code Stroke Workflow and Early CT Thrombolytic Administration2026
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  3. 3Association Between Pre-Hospital Stroke Code Activation Indicators and Short-Term Clinical Outcomes in Acute Stroke: a Cross sectional Study2024
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