Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population

被引：4

作者：

Olive-Gadea, Marta ^{[1
]}

Perez de la Ossa, Natalia ^{[2
]}

Jovin, Tudor ^{[3
]}

Abilleira, Sonia ^{[4
]}

Jimenez, Xavier ^{[5
]}

Cardona, Pere ^{[6
]}

Chamorro, Angel ^{[7
]}

Flores, Alan ^{[8
]}

Silva, Yolanda ^{[9
]}

Purroy, Francesc ^{[10
]}

Marti-Fabregas, Joan ^{[11
]}

Rodriguez-Campello, Ana ^{[12
]}

Zaragoza, Josep ^{[13
]}

Krupinski, Jerzy ^{[14
]}

Canovas, David ^{[15
]}

Gomez Choco, Manuel ^{[16
]}

Mas, Natalia ^{[17
]}

Palomeras, Ernest ^{[18
]}

Cocho, Dolores ^{[19
]}

Aragones, Josep M. ^{[20
]}

Repullo, Carmen ^{[21
]}

Sanjurjo, Eduard ^{[22
]}

Carrion, Dolores ^{[23
]}

Catena, Esther ^{[24
]}

Costa, Xavier ^{[25
]}

Almendros, M. Cruz ^{[26
]}

Barcelo, Miquel ^{[27
]}

Monedero, Jordi ^{[28
]}

Rybyeva, Maria ^{[29
]}

Diaz, Gloria ^{[30
]}

Ribo, Marc ^{[1
]}

机构：

[1] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Med, Stroke Unit, Barcelona, Spain

[2] Hosp Badalona Germans Trias & Pujol, Stroke Unit, Badalona, Spain

[3] Cooper Univ Hlth Care, Neurol Dept, Camden, NJ USA

[4] Agcy Hlth Qual & Assessment Catalonia, Stroke Program, Barcelona, Spain

[5] Emergency Med Serv Catalonia, Barcelona, Spain

[6] Hosp Univ Bellvitge, Stroke Unit, Barcelona, Spain

[7] Hosp Clin Barcelona, Stroke Unit, Barcelona, Spain

[8] Hosp Joan XIII, Stroke Unit, Tarragona, Spain

[9] Hosp Josep Trueta, Stroke Unit, Girona, Spain

[10] Hosp Arnau Vilanova, Stroke Unit, Lleida, Spain

[11] Hosp Santa Creu & Sant Pau, Stroke Unit, Barcelona, Spain

[12] Hosp del Mar, Stroke Unit, Barcelona, Spain

[13] Hosp Verge de la Cinta, Neurol Dept, Tortosa, Spain

[14] Hosp Mutua Terrassa, Neurol Dept, Terrassa, Spain

[15] Hosp Parc Tauli, Neurol Dept, Sabadell, Spain

[16] Hosp Moises Broggi, Neurol Dept, St Joan Despi, Spain

[17] Althaia Xarxa Assistencial Univ, Neurol Dept, Manresa, Spain

[18] Hosp Mataro, Neurol Dept, Mataro, Spain

[19] Hosp Gen Granollers, Neurol Dept, Granollers, Spain

[20] Consorci Hosp Vic, Neurol Dept, Vic, Spain

[21] Fundacio St Hosp, Neurol Dept, La Seu Durgell, Spain

[22] Hosp Comarcal Pallars, Neurol Dept, Tremp, Spain

[23] Hosp Mora dEbre, Emergency Dept, Mora Debre, Spain

[24] Consorci Sanitari Alt Penedes Garraf, Neurol Dept, Vilafranca Del Penedes, Spain

[25] Hosp Figueres, Emergency Dept, Figueres, Spain

[26] Hosp Palamos, Internal Med, Palamos, Spain

[27] Hosp Cerdanya, Emergency Dept, Puigcerda, Spain

[28] Hosp Igualada, Igualada, Spain

[29] Hosp Olot, Emergency Dept, Olot, Spain

[30] Hosp Campdevanol, Emergency Dept, Campdevanol, Spain

来源：

INTERNATIONAL JOURNAL OF STROKE | 2023年 / 18卷 / 02期

关键词：

Stroke network; workflow; territorial disparities; ISCHEMIC-STROKE; OUTCOMES; THERAPY; TIME; THROMBECTOMY; ASSOCIATION; CARE;

D O I：

10.1177/17474930221093523

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Acute ischemic stroke patients not referred directly to a comprehensive stroke center (CSC) have reduced access to endovascular treatment (EVT). The RACECAT trial is a population-based cluster-randomized trial, designed to compare mothership and drip-and-ship strategies in acute ischemic stroke patients outside the catchment area of a CSC. Aims: To analyze the evolution of performance indicators in the regions that participated in RACECAT. Methods: This retrospective longitudinal observational study included all stroke alerts evaluated by emergency medical services in Catalonia between February 2016 and February 2020. Cases were classified geographically according to the nearest SC: local SC (Local-SC) and CSC catchment areas. We analyzed the evolution of EVT rates and relevant workflow times in Local-SC versus CSC catchment areas over three study periods: P1 (February 2016 to April 2017: before RACECAT initiation), P2 (May 2017 to September 2018), and P3 (October 2018 to February 2020). Results: We included 20603 stroke alerts, 10,694 (51.9%) of which were activated within Local-SC catchment areas. The proportion of patients receiving EVT within Local-SC catchment areas increased (P1 vs. P3: 7.5% (95% confidence interval (CI), 6.4-8.7) to 22.5% (95% CI, 20.8-24.4) p < 0.001). Inequalities in the odds of receiving EVT were reduced for patients from CSC versus Local-SC catchment areas (P1: odds ratio (OR) 3.9 (95% CI, 3.2-5) vs. P3: OR 1.5 (95% CI, 1.3-1.7) In Local-SC, door-to-image (P1: 24 (interquartile range (IQR) 15-36), P2: 24 (15-35), P3: 21 (13-32) min, p < 0.001) and door-to-needle times (P1: 42 (31-60), P2: 41 (29-58), P3: 35 (25-50) p < 0.001) reduced. Time from Local-SC arrival to groin puncture also decreased over time (P1: 188 [151-229], P2: 190 (157-233), P3: 168 (127-215) min, p < 0.001). Conclusion: An increase in EVT rates in Local-SC regions with a significant decrease in workflow times occurred during the period of the RACECAT trial.

引用

页码：229 / 236

页数：8

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