1Graduate School of Public Health, Seoul National University, Seoul, Korea
2Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Korea
3Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
4Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
5Health Insurance Review and Assessment Service, Wonju, Korea
6Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Copyright © 2023 The Korean Society for Preventive Medicine
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Characteristics | PSHs-without-EVT (n=563) |
PSHs-with-EVT (n=4164) |
TCHs (n=3224) |
Total (n=7954) |
---|---|---|---|---|
Age (y) | ||||
18–59 | 64 (11.4) | 793 (19.0) | 598 (18.5) | 1455 (18.3) |
60–69 | 87 (15.5) | 740 (17.8) | 634 (19.7) | 1461 (18.4) |
70–79 | 158 (28.1) | 1351 (32.4) | 1094 (33.9) | 2603 (32.7) |
>80 | 254 (45.1) | 1283 (30.8) | 898 (27.9) | 2435 (30.6) |
| ||||
Sex | ||||
Male | 250 (44.4) | 2181 (52.3) | 1689 (52.4) | 4120 (51.8) |
Female | 313 (55.6) | 1986 (47.7) | 1535 (47.6) | 3834 (48.2) |
| ||||
Hospital arrival time (hr) | ||||
0.0–4.5 | 328 (58.3) | 2355 (56.5) | 1760 (54.6) | 4443 (55.9) |
4.5–6.0 | 43 (7.6) | 298 (7.2) | 248 (7.7) | 589 (7.4) |
6.0–24.0 | 192 (34.1) | 1514 (36.3) | 1216 (37.7) | 2922 (36.7) |
| ||||
NIHSS | ||||
6–15 (moderate) | 346 (61.5) | 2870 (68.9) | 2224 (69.0) | 5440 (68.4) |
16–20 (moderate to severe) | 113 (20.1) | 654 (15.7) | 621 (19.3) | 1388 (17.5) |
21–42 (severe) | 104 (18.5) | 643 (15.4) | 379 (11.8) | 1126 (14.2) |
| ||||
CCI | ||||
0 | 453 (80.5) | 3451 (82.8) | 2645 (82.0) | 6549 (82.3) |
1 | 71 (12.6) | 427 (10.2) | 356 (11.0) | 854 (10.7) |
2 | 26 (4.6) | 181 (4.3) | 148 (4.6) | 355 (4.5) |
≥3 | 13 (2.3) | 108 (2.6) | 75 (2.3) | 196 (2.5) |
| ||||
Treatment | ||||
No treatment | 430 (76.4) | 2459 (59.0) | 1769 (54.9) | 4658 (58.6) |
IVT | 67 (11.9) | 718 (17.2) | 530 (16.4) | 1315 (16.5) |
EVT | - | 227 (5.4) | 389 (12.1) | 616 (7.7) |
IVT and EVT | - | 248 (6.0) | 300 (9.3) | 548 (6.9) |
| ||||
Case-fatality rate | ||||
30-day | 92 (16.3) | 615 (14.8) | 356 (11.0) | 1063 (13.4) |
1-y | 211 (37.5) | 1305 (31.3) | 846 (26.2) | 2362 (29.7) |
Characteristics | PSHs-without-EVT (n=64) |
PSHs-with-EVT (n=84) |
TCHs (n=29) |
Total (n=177) |
---|---|---|---|---|
No. of hospitals with a stroke unit | 4 (5.9) | 39 (31.7) | 29 (50.0) | 72 (28.9) |
No. of neurologists | 3.7 (0, 17) | 11.9 (0, 32) | 27.5 (5, 85) | 11.5 (0, 85) |
No. of neurosurgeons | 4.5 (0, 16) | 14.6 (3, 57) | 28.5 (4, 93) | 13.2 (0, 93) |
No. of rehabilitation medicine specialists | 2.0 (0, 17) | 6.6 (0, 24) | 13.2 (2, 30) | 6.0 (0, 30) |
No. of AIS patients | 8.8 (1, 38) | 48.2 (1, 222) | 115.0 (14, 237) | 44.9 (1, 237) |
No. of annual EVT procedures | 0.0 (0, 0) | 8.8 (1, 70) | 35.1 (16, 82) | 6.6 (0, 73) |
30-day CFR (%) | 14.6 (0, 100) | 14.1 (0, 50) | 10.5 (1.49, 21.4) | 13.7 (0, 100) |
1-y CFR (%) | 36.0 (0, 100) | 32.1 (0, 100) | 26.4 (8.33, 53.3) | 32.6 (0, 100) |
Characteristics | 30-day CFR | 1-y CFR |
---|---|---|
Patient-level | ||
Age | 1.02 (1.02, 1.03) | 1.07 (1.07, 1.07) |
Female | 1.02 (0.94, 1.10) | 0.72 (0.68, 0.76) |
CCI | 1.31 (1.26, 1.36) | 1.48 (1.42, 1.53) |
NIHSS | 1.16 (1.15, 1.16) | 1.14 (1.13, 1.14) |
| ||
Hospital-level | ||
PSHs-without-EVT |
1.00 (reference) | 1.00 (reference) |
PSHs-with-EVT |
1.16 (0.98, 1.38) | 1.03 (0.91, 1.17) |
TCHs |
0.92 (0.76, 1.12) | 0.84 (0.73, 0.96) |
Values are presented as number (%). NIHSS, National Institute of Health Stroke Scale; CCI, Charlson comorbidity index; IVT, intravenous thrombolysis; EVT, endovascular thrombectomy; PSH, primary stroke hospital; TCH, thrombectomy-capable hospital. PSHs-without-EVT were defined as hospitals that did not conduct EVTs during the data collection period. PSHs-with-EVT were defined as hospitals that either performed <15 EVTs per year or did not have a stroke unit with stroke specialists. TCHs were defined as hospitals that had stroke units with stroke specialists (neurology, neurosurgery, and rehabilitation medicine departments) and conducted ≥15 EVTs per year.
Values are presented as number (%) or mean (minimum, maximum). EVT, endovascular thrombectomy; PSH, primary stroke hospital; TCH, thrombectomy-capable hospital; AIS, acute ischemic stroke; CFR, case-fatality rate. PSHs-without-EVT were defined as hospitals that did not conduct EVTs during the data collection period. PSHs-with-EVT were defined as hospitals that either performed <15 EVTs per year or did not have a stroke unit with stroke specialists. TCHs were defined as hospitals that had stroke units with stroke specialists (neurology, neurosurgery, and rehabilitation medicine departments) and conducted ≥15 EVTs per year.
Values are presents as odds ratio (95% confidence interval). Intraclass correlation coefficient (ICC) of 30-day CFR was 0.062. ICC of 1-year CFR was 0.027. CFR, case-fatality rate; NIHSS, National Institute of Health Stroke Scale; CCI, Charlson comorbidity index; IVT, intravenous thrombolysis; EVT, endovascular thrombectomy; PSHs, primary stroke hospitals; TCH, thrombectomy-capable hospital. PSHs-without-EVT were defined as hospitals that did not conduct EVTs during the data collection period. PSHs-with-EVT were defined as hospitals that either performed ≤15 EVTs per year or did not have a stroke unit with stroke specialists. TCHs were defined as hospitals that had stroke units with stroke specialists (neurology, neurosurgery, and rehabilitation medicine departments) and conducted ≥15 EVTs per year.