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Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvement

Journal of Korean Medical Science 2020년 35권 41호 p.347 ~ 347
강지훈, 김성은, 박홍균, 조용진, 김준엽, 이건주, 박종무, 박광열, 이경복, 이수주, 이지성, 이준영, 양기화, 최아름, 강미연, 최낙천, Gorelick Philip B., 배희준,
소속 상세정보
강지훈 ( Kang Ji-Hoon ) - 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
박홍균 ( Park Hong-Kyun ) - Inje University Ilsan Paik Hospital Department of Neurology
조용진 ( Cho Yong-Jin ) - Inje University Ilsan Paik Hospital Department of Neurology
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
박종무 ( Park Jong-Moo ) - Eulji University Nowon Eulji Medical Center Department of Neurology
박광열 ( Park Kwang-Yeol ) - Chung-Ang University Hospital Department of Neurology
이경복 ( Lee Kyung-Bok ) - Soonchunhyang University Hospital Department of Neurology
이수주 ( Lee Soo-Joo ) - Eulji University Daejeon Eulji Medical Center Department of Neurology
이지성 ( Lee Ji-Sung ) - Asan Medical Center Clinical Research Center
이준영 ( Lee June-Young ) - Korea University college of Medicine Department of Biostatistics
양기화 ( Yang Ki-Hwa ) - Health Insurance Review and Assessment Service
최아름 ( Choi Ah-Rum ) - Health Insurance Review and Assessment Service
강미연 ( Kang Mi-Yeon ) - Health Insurance Review and Assessment Service
최낙천 ( Choi Nack-Cheon ) - Gyeongsang National University College of Medicine Department of Neurology
 ( Gorelick Philip B. ) - Northwestern University Feinberg School of Medicine Department of Neurology
배희준 ( Bae Hee-Joon ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology

Abstract


Background: To track triage, routing, and treatment status regarding access to endovascular treatment (EVT) after acute ischemic stroke (AIS) at a national level.

Methods: From national stroke audit data, potential candidates for EVT arriving within 6 hours with National Institute of Health Stroke Scale score of ≥ 7 were identified. Acute care hospitals were classified as thrombectomy-capable hospitals (TCHs, ≥ 15 EVT cases/year) or primary stroke hospital (PSH, < 15 cases/year), and patients' initial routes and subsequent inter-hospital transfer were described. Impact of initial routing to TCHs vs. PSHs on EVT and clinical outcomes were analyzed using multilevel generalized mixed effect models.

Results: Out of 14,902 AIS patients, 2,180 (14.6%) were EVT candidates. Eighty-one percent of EVT candidates were transported by ambulance, but only one-third were taken initially to TCHs. Initial routing to TCHs was associated with greater chances of receiving EVT compared to initial routing to PSHs (33.3% vs 12.1%, P < 0.001; adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.59?2.92) and favorable outcome (38.5% vs. 28.2%, P < 0.001; aOR, 1.52; 95% CI, 1.16?2.00). Inter-hospital transfers to TCHs occurred in 17.4% of those initially routed to a PSH and was associated with the greater chance of EVT compared to remaining at PSHs (34.8% vs. 7.5%, P < 0.001), but not with better outcomes.

Conclusion: Two-thirds of EVT candidates were initially routed to PSHs despite greater chance of receiving EVT and having favorable outcomes if routed to a TCH in Korea. Process improvement is needed to direct appropriate patients to TCHs.

키워드

Stroke; Endovascular Treatment; Stroke Center; Organization; Transfer

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