PT  - JOURNAL ARTICLE
AU  - Sui, Yi
AU  - Luo, Jianfeng
AU  - Dong, Chunyao
AU  - Zheng, Liqiang
AU  - Zhao, Weijin
AU  - Zhang, Yao
AU  - Xian, Ying
AU  - Zheng, Huaguang
AU  - Yan, Bernard
AU  - Parsons, Mark
AU  - Ren, Li
AU  - Xiao, Ying
AU  - Zhu, Haoyue
AU  - Ren, Lijie
AU  - Fang, Qi
AU  - Yang, Yi
AU  - Liu, Weidong
AU  - Xu, Bing
TI  - Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months
AID  - 10.1136/svn-2020-000332
DP  - 2020 Sep 24
TA  - Stroke and Vascular Neurology
PG  - svn-2020-000332
4099  - http://svn.bmj.com/content/early/2020/09/23/svn-2020-000332.short
4100  - http://svn.bmj.com/content/early/2020/09/23/svn-2020-000332.full
AB  - Background The rate of intravenous thrombolysis for acute ischaemic stroke remains low in China. We investigated whether the implementation of a citywide Acute Stroke Care Map (ASCaM) is associated with an improvement of acute stroke care quality in a Chinese urban area.Methods The ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary hospitals. We identified 7827 patients with ischaemic stroke admitted from April to October 2017, and 506 patients underwent thrombolysis were finally included for analysis.Results Compared with ‘pre-ASCaM period’, we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours (65.4% vs 54.5%; adjusted OR, 1.724; 95% CI 1.21 to 2.45; p=0.003) during ‘ASCaM period’. In multivariate analysis models, ‘ASCaM period’ was associated with a significant reduction in onset-to-door time (114.1±55.7 vs 135.7±58.4 min, p=0.0002) and onset-to-needle time (ONT) (169.2±58.1 vs 195.6±59.3 min, p<0.0001). Yet no change was found in door-to-needle time. Clinical outcomes such as symptomatic intracranial haemorrhage, favourable functional outcome (modified Rankin Scale ≤2) and in-hospital mortality remained unchanged.Conclusion The implementation of ASCaM was significantly associated with increased rates of intravenous thrombolysis and shorter ONT. The ASCaM may, in proof-of-principle, serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions.