Department of Neurology, Stroke and Vascular Neurology Service, Jose R. Reyes Memorial Medical Center, Manila, Philippines.
Cerebrovasc Dis Extra. 2024;14(1):95-100. doi: 10.1159/000540484. Epub 2024 Jul 23.
The Hub-and-Spoke stroke system seeks to enhance the efficiency of stroke care by establishing a cohesive network between healthcare facilities providing quality stroke care to patients. This study endeavors to evaluate the effectiveness and characterize the outcomes of acute ischemic stroke patients treated within the Hub-and-Spoke hospital system over 2 years. The assessment focused on thrombolysis rates, mortality, and disability at 3-month follow-up.
We conducted a retrospective single-center review to assess the service delivery and outcomes of acute ischemic stroke patients within the Hub-and-Spoke framework which was implemented in Q3 2021. The Hub-and-Spoke model aimed to provide appropriate neurological care for stroke patients, growing from four to eight spoke hospitals in 2 years.
The study consisted of 132 stroke patients transferred to the hub hospital, and 42 (31.8%) of them had acute ischemic stroke. Among these 42 ischemic stroke patients, 76% of them were candidates for thrombolysis with a mean NIHSS of 12 (6-22). Among the subset of 32 patients eligible for intervention within the specified time window, a total of 23 individuals, constituting 72% received r-TPA. Regarding patients administered r-TPA, 91.2% demonstrated favorable functional outcomes with an mRS score of 0-1, while 8.7% exhibited a score of 2-3. Among those not given r-TPA, the mean NIHSS was 17 (ranging from 2 to 32). Their functional outcomes after 3 months revealed 52.5% with an mRS score of 0-1, 16% with a score of 2-3, 21.2% with a score of 4-5, and 10.5% with an mRS score of 6.
Hub-and-Spoke networks represent a crucial advancement in stroke treatment, particularly for facilities lacking the capacity to manage strokes effectively. By leveraging added expertise and reducing the time from onset to diagnosis to treatment, these networks have significantly enhanced patient care. This enhancement is particularly evident in the increased rate of thrombolysis, resulting in reduced morbidity and prevention of mortality.
枢纽辐射式卒中系统通过在为患者提供优质卒中护理的医疗机构之间建立一个有凝聚力的网络，旨在提高卒中护理的效率。本研究旨在评估 2 年内接受枢纽辐射式医院系统治疗的急性缺血性卒中患者的疗效，并对其结局进行特征描述。评估重点是溶栓率、死亡率和 3 个月随访时的残疾情况。
我们进行了一项回顾性单中心研究，以评估 2021 年第 3 季度实施的枢纽辐射式框架内急性缺血性卒中患者的服务提供情况和结局。枢纽辐射式模式旨在为卒中患者提供适当的神经科护理，在 2 年内从 4 家扩展到 8 家辐射医院。
该研究纳入了 132 例转诊至枢纽医院的卒中患者，其中 42 例（31.8%）为急性缺血性卒中患者。在这 42 例缺血性卒中患者中，76%的患者适合溶栓，NIHSS 平均为 12（6-22）。在符合特定时间窗内干预条件的 32 例患者亚组中，共有 23 例（72%）接受了 r-TPA 治疗。接受 r-TPA 治疗的患者中，91.2%的患者功能结局良好，mRS 评分为 0-1，8.7%的患者评分为 2-3。未接受 r-TPA 治疗的患者 NIHSS 平均为 17（范围为 2-32）。他们 3 个月后的功能结局显示，mRS 评分为 0-1 的患者占 52.5%，评分为 2-3 的患者占 16%，评分为 4-5 的患者占 21.2%，评分为 6 的患者占 10.5%。
枢纽辐射式网络是卒中治疗的重要进展，对于那些缺乏有效管理卒中能力的机构尤为重要。通过利用额外的专业知识和减少从发病到诊断再到治疗的时间，这些网络显著改善了患者的护理。这种改善在溶栓率的提高上尤为明显，从而降低了发病率和死亡率。
