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States stroke deaths get scrutiny

Ongoing study finds 4 factors that may play part in high fatality rate

Oregon has one of the country's highest and long-standing death rates from stroke it's in the top five and researchers are getting closer to finding out why.

A yearlong study of 1,599 stroke patients and the care they received at 16 Oregon hospitals showed at least four trends that could explain Oregon's high death rate, said Dr. Ted Lowenkopf, medical director of the Providence Stroke Center in Portland and the project's lead clinical adviser.

The findings were trends, not conclusions, and will be analyzed more fully in the study's second year, Lowenkopf said. Among the findings:

• Most of the patients 41 percent had signed 'do not resuscitate' or other documents that limited the care doctors could give them. Next year's study will try to find out how much effect such orders have on stroke death rates.

• Neurosurgeons and neurologists were consulted in only 59 percent of the stroke cases studied. Next year's study will look at the effect such consultations would have on a patient's prognosis, Lowenkopf said.

• Oregon doctors use the clot-busting drug t-PA more often than the national average. The drug, the FDA's only approved stroke treatment, must be given within three hours after a patient suffers a stroke. Lowenkopf wasn't sure of the significance, which will be studied over the next year.

• Most ambulances do not use lights and sirens when taking stroke patients to hospitals. 'It may not make a difference in terms of urgency, but we need to find out,' Lowenkopf said.

The study was funded with a $704,000 grant from the national Centers for Disease Control and Prevention and coordinated by the Providence Center for Outcomes Research in Portland. The Centers for Disease Control has renewed the grant for another year.

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