Graduate School of Public Health, Seoul National University, Seoul, Korea.
Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Korea.
J Prev Med Public Health. 2023 Mar;56(2):145-153. doi: 10.3961/jpmph.22.318. Epub 2023 Mar 31.
Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume.
From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression.
Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96).
The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.
尽管难以定义卒中治疗质量，但中重度神经功能缺损的急性缺血性卒中（AIS）患者可能受益于能够进行血管内取栓术（EVT）的医院（TCH），这些医院具备卒中单元、卒中专家以及大量的血管内取栓术（EVT）病例量。
从 2013 年至 2016 年收集的国家审核数据中，确定了发病 24 小时内 NIHSS 基线评分≥6 的潜在 EVT 候选患者。将医院分为 TCH（≥15 例 EVT/年、卒中单元和卒中专家）、不具备 EVT 的初级卒中医院（PSH-Without-EVT，0 例 EVT/年）和 PSH-With-EVT。采用随机截距多水平逻辑回归分析 30 天和 1 年病死率（CFR）。
在 35004 例 AIS 患者中，纳入本研究的 EVT 候选患者有 7954 例（22.7%）。PSH-Without-EVT 的平均 30 天 CFR 为 16.3%，PSH-With-EVT 为 14.8%，TCH 为 11.0%。PSH-Without-EVT 的平均 1 年 CFR 为 37.5%，PSH-With-EVT 为 31.3%，TCH 为 26.2%。在 TCH 中，30 天 CFR 未见显著降低（比值比[OR]，0.92；95%置信区间[CI]，0.76 至 1.12），但 1 年 CFR 显著降低（OR，0.84；95%CI，0.73 至 0.96）。
当 EVT 候选患者在 TCH 接受治疗时，1 年 CFR 显著降低。TCH 不仅根据 EVT 数量定义，还根据卒中单元和卒中专家的存在来定义。这支持韩国需要 TCH 认证，并提示每年 EVT 病例量可用于认定 TCH。
