Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvementopen access
- Kang, Jihoon; 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, Juneyoung; Yang, Ki Hwa; Choi, Ah Rum; Kang, Mi Yeon; Choi, Nack-Cheon; Gorelick, Philip B.; Bae, Hee Joon
- Issue Date
- KOREAN ACAD MEDICAL SCIENCES
- Stroke; Endovascular Treatment; Stroke Center; Organization; Transfer
- JOURNAL OF KOREAN MEDICAL SCIENCE, v.35, no.41
- Journal Title
- JOURNAL OF KOREAN MEDICAL SCIENCE
- 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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- College of Medicine > Department of Medicine > Journal Articles
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