Article Figures & Data
Figures
- Figure 1
Flow of acute stroke triage protocol. The emergency medical service (EMS) communicators receive the call, recognise the signs and symptoms of stroke, as well as prioritise the nearest ambulance dispatch. After the ambulance arrival on the scene, EMS staff perform and document the results of prehospital stroke identification screen. If stroke is suspected, the time last known well (LKW) is identified and documented. If the LKW is less than 4.5 hours, the patient is transported directly to the nearest qualified hospital and the receiving hospital prenotified. If not, the patient will be transported to the nearest hospital.
- Figure 2
Initial version of the stroke emergency map. The map only showed hospitals that have thrombolysis capabilities. It showed some large geographical areas with high population density that have no one qualified hospital, such as the northern part of Baoan District, Pingshan District and Dapeng District. Red ‘▲’ indicated qualified hospitals that have stroke care capabilities.
- Figure 3
Updated version of the stroke emergency map. The map showed hospitals that have thrombolysis and thrombectomy capabilities, newly qualified hospitals (Shenzhen Baoan Second People’s Hospital and Shenzhen Baoan Traditional Chinese Medicine Hospital), and new sites undergoing construction or planned (Shenzhen Songgang People’s Hospital, Shenzhen Pingshan New District People’s Hospital and Shenzhen Dapeng Kuichong People’s Hospital). Red ‘▲’ indicated hospitals that have thrombolysis capabilities. Red ‘★’ indicated hospitals that have both thrombolysis and thrombectomy capabilities. Black ‘▼’ indicated a new site under construction. ‘○’ indicated a new planned site.
- Figure 4
Comparison of the number of patients treated with rt-PA thrombolysis in 20 qualified hospitals. Sixteen of 20 hospitals had an increase in the number of rt-PA-treated patients, especially Shenzhen Longgang People’s Hospital, University of Chinese Academy of Sciences Shenzhen Hospital and Peking University Shenzhen Hospital, while 4 of 20 hospitals had the opposite result. rt-PA, recombinant tissue plasminogen activator.
Tables
- Table 1
Comparison of patients with acute ischaemic stroke before and after implementation of the stroke emergency map
Before map After map P value Number (%) of patients treated with rt-PA thrombolysis 568/6843 (8.3) 802/8268 (9.7) 0.003 Number (%) of patients treated with endovascular thrombectomy 60/6843 (0.9) 136/8268 (1.6) <0.001 Median time between receipt of the call and arrival on the scene (min) (IQR） 17.0 (7.0) 9.0 (3.8) <0.001 Median onset-to-needle time (min) (IQR） 175.5 (67.8) 149.5 (71.8) 0.039 Median door-to-needle time (min) (IQR） 71.5 (43.8) 51.5 (26.8) <0.001 Number (%) of rt-PA-treated patients within various distances of Shenzhen Second People’s Hospital ≤3 km
3–5 km
5–10 km
>10 km10/56 (17.9)
11/56 (19.6)
15/56 (26.8)
20/56 (35.7)9/58 (15.5)
10/58 (17.2)
15/58 (25.9)
24/58 (41.4)0.738
0.741
0.911
0.535In 20 qualified hospitals, the number of patients with acute stroke treated with rt-PA thrombolysis increased from 568 to 802, and the rate of rt-PA thrombolysis increased from 8.3% to 9.7%. The number of patients treated with endovascular thrombectomy increased from 60 to 136, and the rate of patients treated with endovascular thrombectomy increased from 0.9% to 1.6%. Furthermore, the median time between receipt of the call and arrival on the scene decreased significantly. In Shenzhen Second People’s Hospital, the median onset-to-needle time and door-to-needle time for rt-PA-treated patients decreased by 26 min and 20 min, respectively. The proportion of rt-PA-treated patients within various geographical distances of Shenzhen Second People’s Hospital did not differ significantly.
rt-PA, recombinant tissue plasminogen activator.
Supplementary file 1
