Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, CB# 7594, Chapel Hill, NC 27599-7594, USA.
Division of Public Health, North Carolina Department of Health and Human Services, NC, USA.
J Stroke Cerebrovasc Dis. 2023 Oct;32(10):107323. doi: 10.1016/j.jstrokecerebrovasdis.2023.107323. Epub 2023 Aug 24.
We conducted a statewide assessment of the availability of stroke treatment, services, and programs in North Carolina (NC) hospitals. We also examined differences in stroke care capabilities between urban, suburban, and rural hospitals and trends over the past 2 decades.
An electronic survey was distributed to all 111 licensed hospitals in NC. Survey questions asked about stroke center certification status (i.e., standardized levels of stroke care capabilities), diagnostic testing, acute treatments and protocols, and post-acute management. Responses were collected from October 2020-April 2021. Select characteristics were compared to those from prior NC surveys in 1998, 2003, and 2008.
All 111 hospitals responded to the survey (100% response rate). Among 108 hospitals providing acute stroke care, 12 (11%) were Comprehensive Stroke Centers or Thrombectomy-Capable Stroke Centers, which were all located in urban or suburban areas. While 38% of urban/suburban hospitals were non-certified, 48% of rural hospitals were non-certified. Non-contrast computed tomography (CT), CT angiography, and alteplase treatment were widely available (100%, 95%, and 99%, respectively). Endovascular thrombectomy was solely available in urban/suburban hospitals (29%). Of non-tertiary hospitals, 81% were using telestroke for treatment and transfer decisions. Compared to prior survey results, the availability of CT angiography (76% in 2008 to 95% in 2020-2021), alteplase treatment (69% in 2008 to 99% in 2020-2021), and acute stroke clinical pathways (47% in 2008 to 90% in 2020-2021) increased. However, having an in-house neurologist on staff dropped from approximately 55% in prior surveys to 21% in the current survey.
Rural NC hospitals were less likely to have advanced diagnostic imaging and treatment capabilities for acute stroke. Temporal trends in staffing with an in-house neurologist and use of telestroke services should be further examined.
我们对北卡罗来纳州（NC）医院的中风治疗、服务和项目的可用性进行了全州评估。我们还研究了城市、郊区和农村医院之间中风护理能力的差异以及过去 20 年来的趋势。
向 NC 所有 111 家许可医院分发了电子调查。调查问题询问了中风中心认证状态（即中风护理能力的标准化水平）、诊断测试、急性治疗和方案以及急性后管理。从 2020 年 10 月至 2021 年 4 月收集了回复。选择的特征与 1998 年、2003 年和 2008 年 NC 调查的特征进行了比较。
所有 111 家医院都对调查做出了回应（100%的回应率）。在 108 家提供急性中风护理的医院中，有 12 家（11%）是综合中风中心或可进行血栓切除术的中风中心，这些中心均位于城市或郊区。虽然 38%的城市/郊区医院未获得认证，但 48%的农村医院未获得认证。非对比 CT、CT 血管造影和阿替普酶治疗广泛可用（分别为 100%、95%和 99%）。血管内血栓切除术仅在城市/郊区医院提供（29%）。在非三级医院中，81%的医院使用远程中风进行治疗和转移决策。与之前的调查结果相比，CT 血管造影的可用性（2008 年的 76%至 2020-2021 年的 95%）、阿替普酶治疗（2008 年的 69%至 2020-2021 年的 99%）和急性中风临床途径（2008 年的 47%至 2020-2021 年的 90%）有所增加。然而，在职员工中拥有内部神经科医生的比例从之前的调查中约 55%下降到当前调查中的 21%。
北卡罗来纳州农村医院在急性中风的先进诊断成像和治疗能力方面的可能性较低。应进一步研究内部神经科医生的人员配备和远程中风服务的使用方面的时间趋势。
