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Introduction Previous studies have shown an association between number of stroke admissions and outcomes. Small hospitals often support more remote areas and we studied national data to determine if an association exists between hospital remoteness and stroke care. Methods Data from the Irish National Audit of Stroke (INAS) on average stroke admissions, adjusted mortality for ischaemic stroke, thrombolysis rate and proportion with door to needle (DTN) ≤45 min were analysed. Hospital remoteness was quantified by distance to the next hospital, nearest neurointerventional centre and location within 10 km of the national motorway network. Results Data for 23 of 24 stroke services were evaluated. Median number of strokes admitted per year was 186 (range 84–497). Nine hospitals (39%) admitted ≥200 stroke patients per year (mean 332). Average adjusted mortality (7.0 vs. 7.3, P  = 0.67 t -test), mean thrombolysis rate (12.1% vs. 9.2%, P  = 0.09) and mean proportion of patients treated ≤45 min (40.4% vs. 31.3%, P  = 0.2) did not differ significantly between higher and lower volume hospitals. Hospitals close to the motorway network (n  = 15) had a higher mean thrombolysis rate (11.9% vs. 7.5%, P  = 0.01 t -test) and proportion DTN ≤45 min (43.7–18.4%, P  < 0.001). Number of stroke admissions did not correlate with mortality (r  = 0.06, P  = 0.78), DTN (r  = 0.12, P  = 0.95) or thrombolysis rate (r  = 0.35, P  = 0.20). Distance to next hospital correlated strongly negatively with DTN (r  = −0.47, P  = 0.02) and thrombolysis rate (−0.43, P  = 0.04). Conclusion Remoteness of hospitals is associated with worse measures of stroke outcome and management. [ABSTRACT FROM AUTHOR]

This document is a response to a letter regarding the impact of prehospital care and door-to-computed tomography scan time on stroke outcomes. The authors address the issues raised by the letter and provide information about the prehospital assessment and care of stroke patients in Ireland. They explain that Ireland has a standardized training protocol for paramedics, and all hospitals can receive pre-notification of suspected strokes from ambulances. They also mention that technical solutions like mobile stroke units have not been extensively assessed in remote areas due to cost and low frequency of use. The authors conclude that optimizing prehospital and emergency care for stroke patients is important, but there is no evidence that patients attending remote hospitals in Ireland receive poorer care in these respects. [Extracted from the article]

The North Dublin Population Stroke Study in 2012[5] showed a 9.5% non-presentation rate of stroke patients. All had active thrombolysis protocols, all had nationally developed imaging protocols and all had access to thrombectomy services with imaging review by Interventional Neuroradiologists through a central imaging system.[3] All units undergo continuous audit. All the stroke patients in the study were admitted to hospitals with organized stroke services, with accredited stroke units and with senior medical and specialized nursing staff trained in stroke care. [Extracted from the article]