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Acute Stroke Care in Korea in 2013?2014: National Averages and Disparities

Journal of Korean Medical Science 2020년 35권 20호 p.167 ~ 167
김준엽 ( Kim Jun-Yup ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology

이건주 ( Lee Keon-Joo ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology
강지훈 ( Kang Ji-Hoon ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology
김범준 ( Kim Beom-Joon ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology
김성은 ( Kim Seong-Eun ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology
 ( Oh Hyun-Ji ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology
박홍균 ( Park Hong-Kyun ) - Inje University Ilsan Paik Hospital Department of Neurology
조용진 ( Cho Yong-Jin ) - Inje University Ilsan Paik Hospital Department of Neurology
박종무 ( Park Jong-Moo ) - Eulji University Nowon Eulji Medical Center Department of Neurology
박광열 ( Park Kwang-Yeol ) - Chung-Ang University College of Medicine Chung-Ang University Hospital Department of Neurology
이경복 ( Lee Kyung-Bok ) - Soonchunhyang University School of Medicine Soonchunhyang University Hospital Department of Neurology
이수주 ( Lee Soo-Joo ) - Eulji University School of Medicine Eulji University Hospital Department of Neurology
 ( Kim Tack-Eun ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
이지성 ( Lee Ji-Sung ) - Asan Medical Center Asan Institute for Life Sciences
이준영 ( Lee June-Young ) - Korea University college of Medicine Department of Biostatistics
양기화 ( Yang Ki-Hwa ) - Health Insurance Review and Assessment Service
 ( Choi Ah-Rum ) - Health Insurance Review and Assessment Service
강미연 ( Kang Mi-Yeon ) - Health Insurance Review and Assessment Service
배희준 ( Bae Hee-Joon ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology

Abstract


Background: This study aimed to describe the current status of acute stroke care in Korea and explore disparities among hospitals and regions.

Methods: The 2013 and 2014 national stroke audit data and the national health insurance claims data were linked and used for this study. Stroke patients hospitalized via emergency rooms within 7 days of stroke onset were selected.

Results: A total of 19,608 patients treated in 216 hospitals were analyzed. Among them 76% had ischemic stroke; 15%, intracerebral hemorrhage (ICH); and 9%, subarachnoid hemorrhage (SAH). Of the hospitals, 31% provided inpatient stroke unit care. Ambulances were used in 56% of cases, and the median interval from onset to arrival was 4.5 hours. One-quarter of patients were referred from other hospitals. Intravenous thrombolysis (IVT) and endovascular treatment (EVT) rates were 11% and 4%, respectively. Three-quarters of the analyzed hospitals provided IVT and/or EVT, whereas 47% of hospitals providing IVT and 67% of hospitals providing EVT had less than one case per month. Decompressive surgery was performed on 28% of ICH patients, and clipping and coiling were performed in 17.2% and 14.3% of SAH patients, respectively. There were noticeable regional disparities between the various interventions, ambulance use, arrival time, and stroke unit availability.

Conclusion: This study describes the current status of acute stroke care in Korea. Despite quite acceptable quality of stroke care, it suggests regional and hospital disparities. Expansion of stroke units, stroke center certification or accreditation, and connections between stroke centers and emergency medical services are highly recommended.

키워드

Stroke; Epidemiology; Cerebral Infarction; Cerebral Hemorrhage; Subarachnoid Hemorrhage
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