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

Authors
Kang, JihoonKim, Seong-EunPark, Hong-KyunCho, Yong-JinKim, Jun YupLee, Keon-JooPark, Jong-MooPark, Kwang-YeolLee, Kyung BokLee, Soo JooLee, Ji SungLee, JuneyoungYang, Ki HwaChoi, Ah RumKang, Mi YeonChoi, Nack-CheonGorelick, Philip B.Bae, Hee Joon
Issue Date
Oct-2020
Publisher
KOREAN ACAD MEDICAL SCIENCES
Keywords
Stroke; Endovascular Treatment; Stroke Center; Organization; Transfer
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.35, no.41, pp 1 - 12
Pages
12
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
Volume
35
Number
41
Start Page
1
End Page
12
URI
https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/53800
DOI
10.3346/jkms.2020.35.e347
ISSN
1011-8934
1598-6357
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.
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의과대학 (의학부(임상-서울))
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