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    Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months.

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    Author
    Sui, Y; Luo, J; Dong, C; Zheng, L; Zhao, W; Zhang, Y; Xian, Y; Zheng, H; Yan, B; Parsons, M; ...
    Date
    2020-09-24
    Source Title
    Stroke and Vascular Neurology
    Publisher
    BMJ
    University of Melbourne Author/s
    Yan, Bernard
    Affiliation
    Medicine and Radiology
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Sui, Y., Luo, J., Dong, C., Zheng, L., Zhao, W., Zhang, Y., Xian, Y., Zheng, H., Yan, B., Parsons, M., Ren, L., Xiao, Y., Zhu, H., Ren, L., Fang, Q., Yang, Y., Liu, W. & Xu, B. (2020). Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months.. Stroke Vasc Neurol, pp.svn-2020-000332-. https://doi.org/10.1136/svn-2020-000332.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/252196
    DOI
    10.1136/svn-2020-000332
    Abstract
    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.

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