Stroke is a leading cause of death and disability throughout the world. In Thailand, the prevalence of stroke is estimated to be 1,880/100,000. Intravenous recombinant tissue plasminogen activator (rt-PA) has been shown to lead to significantly better outcomes. Hospitals in Thailand are divided into three levels, similar to hospitals in other Asian countries. These are community hospitals (CHs), regional hospitals (RHs), and tertiary hospitals (THs). Referrals travel up stepwise from CHs to RHs to THs. In Thailand, rt-PA therapy began to be implemented in 1996. This study, aimed to evaluate the quality of acute ischemic stroke care in the various hospital levels.

A total of 947 patients, 169 patients from CHs, 629 from regional hospitals (RH) and 149 from the tertiary hospital (TH) were included in the final analysis. The CH group had a higher median age but lower median initial NIHSS than the RH and TH groups (median age = 70, 66 and 67 years, respectively, and initial NIHSS = 6, 8, and 9, respectively). The CH group had shorter onset-to-needle times for rt-PA than the other two groups (147 vs 178.5 and 180 min). The CH group had a lower proportion of asymptomatic intracerebral hemorrhage (0.6%), and lower mortality rate (1.2%) than either the RH or TH group.