Cargando…

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

Prehospital delay is one of the major causes of low rate of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis for acute ischaemic stroke in China. Regional emergency systems have been proven a successful approach to improve access to thrombolysis. Shenzhen is a high populatio...

Descripción completa

Detalles Bibliográficos
Autores principales: Ye, Shisheng, Hu, Shiyu, Lei, Zhihao, Li, Zhichao, Li, Weiping, Sui, Yi, Ren, Lijie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812643/
https://www.ncbi.nlm.nih.gov/pubmed/31709116
http://dx.doi.org/10.1136/svn-2018-000212
_version_ 1783462679251255296
author Ye, Shisheng
Hu, Shiyu
Lei, Zhihao
Li, Zhichao
Li, Weiping
Sui, Yi
Ren, Lijie
author_facet Ye, Shisheng
Hu, Shiyu
Lei, Zhihao
Li, Zhichao
Li, Weiping
Sui, Yi
Ren, Lijie
author_sort Ye, Shisheng
collection PubMed
description Prehospital delay is one of the major causes of low rate of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis for acute ischaemic stroke in China. Regional emergency systems have been proven a successful approach to improve access to thrombolysis. Shenzhen is a high population density city with great geographical disparity of healthcare resources, leading to limited access to rt-PA thrombolysis for most patients with acute ischaemic stroke. To improve rapid access to rt-PA thrombolysis in Shenzhen, a Shenzhen stroke emergency map was implemented by Shenzhen healthcare administrations. This map comprised certification of qualified local hospitals, identification of patients with stroke, acute stroke transport protocol and maintenance of the map. We conducted a retrospective observational study to compare consecutive patients with acute stroke arriving at qualified local hospitals before and after implementation of the Shenzhen stroke emergency map. After implementation of the map, the rate of patients receiving rt-PA thrombolysis increased from 8.3% to 9.7% (p=0.003), and the rate of patients treated with endovascular thrombectomy increased from 0.9% to 1.6% (p<0.001). Sixteen of 20 hospitals have an increase in the number of patients with stroke treated with rt-PA thrombolysis. The median time between receipt of the call and arrival on the scene reduced significantly (17.0 min vs 9.0 min, p<0.001). In Shenzhen Second People’s Hospital, the median onset-to-needle time and door-to-needle time were reduced (175.5 min vs 149.5 min, p=0.039; 71.5 min vs 51.5 min, p<0.001). No statistically significant differences were found in the proportion of rt-PA-treated patients within various geographical distances. Currently, there are more than 40 cities in China implementing a stroke emergency map. The Shenzhen stroke emergency map improves access to rt-PA thrombolysis for acute ischaemic stroke, and the novel model has been expanded to multiple areas in China. Future efforts should be conducted to optimise the stroke emergency map.
format Online
Article
Text
id pubmed-6812643
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-68126432019-11-08 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 Stroke Vasc Neurol Original Article Prehospital delay is one of the major causes of low rate of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis for acute ischaemic stroke in China. Regional emergency systems have been proven a successful approach to improve access to thrombolysis. Shenzhen is a high population density city with great geographical disparity of healthcare resources, leading to limited access to rt-PA thrombolysis for most patients with acute ischaemic stroke. To improve rapid access to rt-PA thrombolysis in Shenzhen, a Shenzhen stroke emergency map was implemented by Shenzhen healthcare administrations. This map comprised certification of qualified local hospitals, identification of patients with stroke, acute stroke transport protocol and maintenance of the map. We conducted a retrospective observational study to compare consecutive patients with acute stroke arriving at qualified local hospitals before and after implementation of the Shenzhen stroke emergency map. After implementation of the map, the rate of patients receiving rt-PA thrombolysis increased from 8.3% to 9.7% (p=0.003), and the rate of patients treated with endovascular thrombectomy increased from 0.9% to 1.6% (p<0.001). Sixteen of 20 hospitals have an increase in the number of patients with stroke treated with rt-PA thrombolysis. The median time between receipt of the call and arrival on the scene reduced significantly (17.0 min vs 9.0 min, p<0.001). In Shenzhen Second People’s Hospital, the median onset-to-needle time and door-to-needle time were reduced (175.5 min vs 149.5 min, p=0.039; 71.5 min vs 51.5 min, p<0.001). No statistically significant differences were found in the proportion of rt-PA-treated patients within various geographical distances. Currently, there are more than 40 cities in China implementing a stroke emergency map. The Shenzhen stroke emergency map improves access to rt-PA thrombolysis for acute ischaemic stroke, and the novel model has been expanded to multiple areas in China. Future efforts should be conducted to optimise the stroke emergency map. BMJ Publishing Group 2019-06-21 /pmc/articles/PMC6812643/ /pubmed/31709116 http://dx.doi.org/10.1136/svn-2018-000212 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Article
Ye, Shisheng
Hu, Shiyu
Lei, Zhihao
Li, Zhichao
Li, Weiping
Sui, Yi
Ren, Lijie
Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke
title Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke
title_full Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke
title_fullStr Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke
title_full_unstemmed Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke
title_short Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke
title_sort shenzhen stroke emergency map improves access to rt-pa for patients with acute ischaemic stroke
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812643/
https://www.ncbi.nlm.nih.gov/pubmed/31709116
http://dx.doi.org/10.1136/svn-2018-000212
work_keys_str_mv AT yeshisheng shenzhenstrokeemergencymapimprovesaccesstortpaforpatientswithacuteischaemicstroke
AT hushiyu shenzhenstrokeemergencymapimprovesaccesstortpaforpatientswithacuteischaemicstroke
AT leizhihao shenzhenstrokeemergencymapimprovesaccesstortpaforpatientswithacuteischaemicstroke
AT lizhichao shenzhenstrokeemergencymapimprovesaccesstortpaforpatientswithacuteischaemicstroke
AT liweiping shenzhenstrokeemergencymapimprovesaccesstortpaforpatientswithacuteischaemicstroke
AT suiyi shenzhenstrokeemergencymapimprovesaccesstortpaforpatientswithacuteischaemicstroke
AT renlijie shenzhenstrokeemergencymapimprovesaccesstortpaforpatientswithacuteischaemicstroke