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KMID : 0191120200350410347
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Journal of Korean Medical Science
2020 Volume.35 No. 41 p.347 ~ p.347
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Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvement
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Kang Ji-Hoon
Kim Seong-Eun
Park Hong-Kyun
Cho Yong-Jin
Kim Jun-Yup
Lee Keon-Joo
Park Jong-Moo
Park Kwang-Yeol
Lee Kyung-Bok
Lee Soo-Joo
Lee Ji-Sung
Lee June-Young
Yang Ki-Hwa
Choi Ah-Rum
Kang Mi-Yeon
Choi Nack-Cheon
Gorelick Philip B.
Bae Hee-Joon
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Abstract
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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.
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KEYWORD
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Stroke, Endovascular Treatment, Stroke Center, Organization, Transfer
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