Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvement
10.3346/jkms.2020.35.e347
- Author:
Jihoon KANG
1
;
Seong-Eun KIM
;
Hong-Kyun PARK
;
Yong-Jin CHO
;
Jun Yup KIM
;
Keon-Joo LEE
;
Jong-Moo PARK
;
Kwang-Yeol PARK
;
Kyung Bok LEE
;
Soo Joo LEE
;
Ji Sung LEE
;
Juneyoung LEE
;
Ki Hwa YANG
;
Ah Rum CHOI
;
Mi Yeon KANG
;
Nack-Cheon CHOI
;
Philip B. GORELICK
;
Hee-Joon BAE
Author Information
1. Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Publication Type:Original Article
- From:Journal of Korean Medical Science
2020;35(41):e347-
- CountryRepublic of Korea
- Language:English
-
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.
