RT Journal Article
SR Electronic
T1 Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 87
OP 94
DO 10.1136/svn-2020-000332
VO 6
IS 1
A1 Sui, Yi
A1 Luo, Jianfeng
A1 Dong, Chunyao
A1 Zheng, Liqiang
A1 Zhao, Weijin
A1 Zhang, Yao
A1 Xian, Ying
A1 Zheng, Huaguang
A1 Yan, Bernard
A1 Parsons, Mark
A1 Ren, Li
A1 Xiao, Ying
A1 Zhu, Haoyue
A1 Ren, Lijie
A1 Fang, Qi
A1 Yang, Yi
A1 Liu, Weidong
A1 Xu, Bing
YR 2021
UL http://svn.bmj.com/content/6/1/87.abstract
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.