Impact of Jilin Province Stroke Emergency Maps on Acute Stroke Care Improvement in Northeast China

Abstract

Objectives: Stroke burden is especially heavy in northeast China. Facilities with the capacity to perform acute reperfusion therapies for stroke are unevenly dispersed and are especially inadequate in rural areas. The aim of this study was to establish an effective measure to improve stroke emergency care, eventually increasing the capacity for reperfusion therapy in Jilin province, a less developed province in northeast China. Methods: We created the Jilin province Stroke Emergency Maps (JSEM), a regional stroke emergency network. Qualified hospitals in Jilin province were integrated into JSEM according to strict inclusion criteria. With constant evaluation and screening, more qualified hospitals may be enrolled into the JSEM, which is updated and published once per year. Locations of hospitals with the capacity to perform intravenous thrombolysis and emergency mechanical thrombectomy were labeled on the map. Results: After strict evaluation and screening, 19 designated hospitals were integrated into the JSEM in August 2017 (baseline). Following the implementation of the JSEM, 21 more designated hospitals (40 in all) were included in 2018, and 48 more designated hospitals were included in 2019. With the guidance of the JSEM, the rate of intravenous thrombolysis in Jilin province increased remarkably from 3.3% (2017, baseline) and 4.6% (2018) to 5.5% (2019). Mean door-to-needle time decreased from 62 min at baseline (2017) to 45 min 2 years later. The number of mechanical thrombectomy was increased from 457 at baseline (2017) to 749 (2018) and 1,137 (2019) per year, respectively, and mean door-to-puncture time was shortened from 136 to 120 min. Conclusion: The JSEM, a regional stroke emergency network, serves to improve patient care for stroke. The map's publication increased rates of intravenous thrombolysis and mechanical thrombectomy. JSEM effectively connected more qualified designated hospitals, stroke patients and emergency medical service systems in Jilin province.

Safety and efficacy of remote ischemic conditioning combined with intravenous thrombolysis for acute ischemic stroke: A multicenter, randomized, parallel-controlled clinical trial (SERIC-IVT) Study design and protocol

“…Safety outcomes include not only 90 day mortality and AEs but also local skin changes and NRS, as well as tolerability assessments. Fourth, we selected centers with qualifications of thrombolysis from JSEM, 24 and the medical records of patients with thrombolysis will be subject to strict quality control by the Jilin Stroke Association. The accuracy of the data can be guaranteed.…”

“…All centers are qualified for IVT and selected from the Jilin Province Stroke Emergency Maps (JSEM). 24…”

“…All centers are qualified for IVT and selected from the Jilin Province Stroke Emergency Maps (JSEM). 24 The study design was approved by the Ethics Committee of the First Hospital of Jilin University. The ethics committee of each center approved this study.…”

The Assessment of Endovascular Therapies in Ischemic Stroke: Management, Problems and Future Approaches

“…Creating a pilot network with referring patients to a superior center (depending on the occlusion of large vessels detected in angioCT) as a reference center would allow avoiding local problems related to a shortage of specialist local staff, and facilitate a personalized approach, guaranteeing the comfort of work of all persons participating in the pilot project as it was done in Poland, like as in China [ 46 ].…”

Safety and efficacy of remote ischemic conditioning combined with endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion of anterior circulation: A multicenter, randomized, parallel-controlled clinical trial (SERIC-EVT): Study protocol

“…All 498 patients, 249 in the control group and another 249 in the treatment group, will be recruited from 10 hospitals that are qualified to perform EVT from the Jilin Province Stroke Emergency Maps in Jilin Province, Northeast China. 14 Investigators from the 10 hospitals will be informed of the study design and flow of our trial prior to enrollment. Figure 1 shows the flow of patient enrollment.…”