Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke

Ye, Shisheng; Hu, Shiyu; Lei, Zhihao; Li, Zhichao; Li, Weiping; Sui, Yi; Ren, Lijie

doi:10.1136/svn-2018-000212

Cited by 9 publications

(21 citation statements)

References 23 publications

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“…Out of 35 articles included in this review, 34 (97.1%) 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 were published in English and one (2.9%) 46 in both English and Spanish. Regarding the origin of the selected studies, 15 (42.9%) studies were performed in the Americas, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 10 (28.6%) in Europe, 14 15 20 23 27 29 32 34 35 46 7 (20.0%) in Asia, 12 19 25 28 33 36 43 and 3 (8.6%) in Oceania. 16 41 42 From the included articles, 15 (42.9%) were performed in the United States of America, 13 1...…”

Section: Resultsmentioning

confidence: 99%

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

et al. 2022

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Background The treatment of acute ischemic stroke with cerebral reperfusion therapy requires rapid care and recognition of symptoms. Objective To analyze the effectiveness of implementing protocols for acute ischemic stroke in reducing care time. Methods Systematic review, which was performed with primary studies in Portuguese, English, and Spanish published between 2011 and 2020. Inclusion criteria: study population should comprise people with acute ischemic stroke and studies should present results on the effectiveness of using urgent care protocols in reducing care time. The bibliographic search was conducted in June 2020 in the LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier, and SocINDEX databases. The articles were selected, and data were extracted by two independent reviewers; the synthesis of the results was performed narratively. The methodological quality of articles was evaluated through specific instruments proposed by the Joanna Briggs Institute. Results A total of 11,226 publications were found, of which 35 were included in the study. Only one study reported improvement in the symptoms-onset-to-door time after protocol implementation. The effectiveness of the therapeutic approach protocols for ischemic stroke was identified in improving door-to-image, image-to-needle, door-to-needle and symptoms-onset-to-needle times. The main limitation found in the articles concerned the lack of clarity in relation to the study population. Conclusions Several advances have been identified in in-hospital care with protocol implementation; however, it is necessary to improve the recognition time of stroke symptoms among those who have the first contact with the person affected by the stroke and among the professionals involved with the prehospital care.

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Section: Resultsmentioning

confidence: 99%

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

et al. 2022

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“…To the best of our knowledge, JSEM is the first province-wide stroke emergency map in China. Prior to establishment of the JSEM, several city-wide stroke emergency maps have been published in Shenzhen city ( 12 ), Shenyang city, and Qingdao city. These cities are densely populated and evenly distributed and located in developed areas with adequate medical resources.…”

Section: Discussionmentioning

confidence: 99%

“…Stroke centers in cities, such as Changchun can provide remote guidance to urban centers to ensure the best interests of stroke patients in remote areas are met. Further, telemedicine may help identify patients who are suspected with large vessel occlusion, while primarily admitted to only thrombolysis-capable hospitals (12). These will be the next direction in the informatization.…”

Section: Perspectivementioning

confidence: 99%

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

Jin

Guo

et al. 2020

Front. Neurol.

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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.

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“…A poor understanding and ability to identify stroke symptoms, prehospital delays, and nonstandardized emergency workflows are the top three factors for delays in timely treatment (Jiang et al., 2016; Pulvers & Watson, 2017). To improve rapid access to rt‐PA, the first stroke emergency map ( SEM ) was launched in Shenzhen in November 2016, and as a result, the rate of patients receiving rt‐PA thrombolysis and endovascular thrombectomy has increased significantly (Ye et al., 2019). Subsequently, the SEM was designed to increase the likelihood that treatment would occur in the golden first‐aid window of “three one hour” (no more than one hour from onset to call for ambulance, no more than one hour from prehospital transfer, and no more than one hour from admission to thrombolysis) and was released in many cities by Chinese healthcare administrations.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Sun³

et al. 2020

Brain and Behavior

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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.

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Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke

Cited by 9 publications

References 23 publications

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

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

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

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