PT  - JOURNAL ARTICLE
AU  - Yi Sui
AU  - Jianfeng Luo
AU  - Chunyao Dong
AU  - Liqiang Zheng
AU  - Weijin Zhao
AU  - Yao Zhang
AU  - Ying Xian
AU  - Huaguang Zheng
AU  - Bernard Yan
AU  - Mark Parsons
AU  - Li Ren
AU  - Ying Xiao
AU  - Haoyue Zhu
AU  - Lijie Ren
AU  - Qi Fang
AU  - Yi Yang
AU  - Weidong Liu
AU  - Bing Xu
TI  - Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months
AID  - 10.1136/svn-2020-000332
DP  - 2021 Mar 01
TA  - Stroke and Vascular Neurology
PG  - 87--94
VI  - 6
IP  - 1
4099  - http://svn.bmj.com/content/6/1/87.short
4100  - http://svn.bmj.com/content/6/1/87.full
SO  - Stroke Vasc Neurol2021 Mar 01; 6
AB  - 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.