Improving timely treatment with a stroke emergency map: The case of northern China

Abstract

Objective The Chinese stroke emergency map ( SEM ) was implemented in 2017 to reduce prehospital and hospital delays for acute ischemic stroke (AIS) patients suitable for intravenous recombinant tissue plasminogen activator (rt‐PA) thrombolysis. However, data on the time delay following the implementation of an SEM in China are limited. Methods Data for suspected stroke patients from the SEM registry center of Taiyuan, Shanxi Province, from August 2017 to July 2019, patients’ characteristics, thrombolysis rate, and functional outcome at 90 days were analyzed. Results One thousand seven hundred and eighty six patients who arrived at hospitals within 4.5 hr of onset were included; 35.9% arrived by emergency medical services (EMSs), and 1,207 (67.6%) of the population received intravenous rt‐PA. As a result of the SEM , the number of patients treated with rt‐PA increased from 63.9% in phase 1 (August 2017 to July 2018) to 70.5% in phase 2 (August 2018 to July 2019). The median onset‐to‐door and onset‐to‐needle times decreased by five minutes (100 [IQR: 62–135] vs. 105 [IQR: 70–145], p = .005) and nine minutes (158 [IQR: 124–197] vs. 167 [IQR: 132–214], p = .001), respectively. Patients in phase 2 achieved greater independent function outcome at 90 days (79.9% vs. 72.1%; adjusted odds ratio, 2.010; 95% confidence interval, 1.444–2.798). The binary logistic regression models revealed that shorter onset‐to‐needle time (OR: 0.994; 95% CI: 0.992–0.997; p < .001) and lower baseline NIHSS scores (OR: 39.120; 95% CI: 23.477–65.188; p < .001 and OR: 18.324; 95% CI: 11.425–29.388; p < .001 and OR: 3.123; 95% CI: 2.044–4.773; p < .001) were significant predictors for the independent function outcome. Conclusion The implementation of a stroke emergency map is more likely to reduce prehospital delays and improve function outcomes. Future efforts should attempt to increase EMS usage.

Impact of stroke center certification on rt-PA thrombolysis after acute ischemic stroke in South China from 2015 to 2020

“…Moreover, the construction of a rapid ''stroke green channel'' in stroke centers helped to improve access to rt-PA among patients with AIS in China. 27,28 It is required to rapidly discriminate stroke patients and initiate intravenous thrombolysis within 60 min after patient arrival, which promotes the implement of thrombolysis. In China, certified stroke centers are assessed for the efficiency of the stroke green channel every year; the certification is cancelled for those who fail the examination.…”