Jun Yup Kim1, Keon Joo Lee1, Jihoon Kang1, Beom Joon Kim1, Seong Eun Kim1, Hyunji Oh1, Hong Kyun Park2, Yong Jin Cho2, Jong Moo Park3, Kwang Yeol Park4, Kyung Bok Lee5, Soo Joo Lee6, Tackeun Kim7, Ji Sung Lee8, Juneyoung Lee9, Ki Hwa Yang10, Ah Rum Choi10, Mi Yeon Kang10, Hee Joon Bae11. 1. Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. 2. Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea. 3. Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea. 4. Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea. 5. Department of Neurology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea. 6. Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea. 7. Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. 8. Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea. 9. Department of Biostatistics, Korea University College of Medicine, Seoul, Korea. 10. Health Insurance Review and Assessment Service, Wonju, Korea. 11. Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. braindoc@snu.ac.kr.
Abstract
BACKGROUND: This study aimed to describe the current status of acute stroke care in Korea and explore disparities among hospitals and regions. METHODS: The 2013 and 2014 national stroke audit data and the national health insurance claims data were linked and used for this study. Stroke patients hospitalized via emergency rooms within 7 days of stroke onset were selected. RESULTS: A total of 19,608 patients treated in 216 hospitals were analyzed. Among them 76% had ischemic stroke; 15%, intracerebral hemorrhage (ICH); and 9%, subarachnoid hemorrhage (SAH). Of the hospitals, 31% provided inpatient stroke unit care. Ambulances were used in 56% of cases, and the median interval from onset to arrival was 4.5 hours. One-quarter of patients were referred from other hospitals. Intravenous thrombolysis (IVT) and endovascular treatment (EVT) rates were 11% and 4%, respectively. Three-quarters of the analyzed hospitals provided IVT and/or EVT, whereas 47% of hospitals providing IVT and 67% of hospitals providing EVT had less than one case per month. Decompressive surgery was performed on 28% of ICH patients, and clipping and coiling were performed in 17.2% and 14.3% of SAH patients, respectively. There were noticeable regional disparities between the various interventions, ambulance use, arrival time, and stroke unit availability. CONCLUSION: This study describes the current status of acute stroke care in Korea. Despite quite acceptable quality of stroke care, it suggests regional and hospital disparities. Expansion of stroke units, stroke center certification or accreditation, and connections between stroke centers and emergency medical services are highly recommended.
BACKGROUND: This study aimed to describe the current status of acute stroke care in Korea and explore disparities among hospitals and regions. METHODS: The 2013 and 2014 national stroke audit data and the national health insurance claims data were linked and used for this study. Strokepatients hospitalized via emergency rooms within 7 days of stroke onset were selected. RESULTS: A total of 19,608 patients treated in 216 hospitals were analyzed. Among them 76% had ischemic stroke; 15%, intracerebral hemorrhage (ICH); and 9%, subarachnoid hemorrhage (SAH). Of the hospitals, 31% provided inpatient stroke unit care. Ambulances were used in 56% of cases, and the median interval from onset to arrival was 4.5 hours. One-quarter of patients were referred from other hospitals. Intravenous thrombolysis (IVT) and endovascular treatment (EVT) rates were 11% and 4%, respectively. Three-quarters of the analyzed hospitals provided IVT and/or EVT, whereas 47% of hospitals providing IVT and 67% of hospitals providing EVT had less than one case per month. Decompressive surgery was performed on 28% of ICHpatients, and clipping and coiling were performed in 17.2% and 14.3% of SAHpatients, respectively. There were noticeable regional disparities between the various interventions, ambulance use, arrival time, and stroke unit availability. CONCLUSION: This study describes the current status of acute stroke care in Korea. Despite quite acceptable quality of stroke care, it suggests regional and hospital disparities. Expansion of stroke units, stroke center certification or accreditation, and connections between stroke centers and emergency medical services are highly recommended.
Authors: Jay Chol Choi; Joong Goo Kim; Chul Hoo Kang; Hee Joon Bae; Jihoon Kang; Soo Joo Lee; Jong Moo Park; Tai Hwan Park; Yong Jin Cho; Kyung Bok Lee; Jun Lee; Dong Eog Kim; Jae Kwan Cha; Joon Tae Kim; Byung Chul Lee; Ji Sung Lee; Anthony S Kim Journal: J Korean Med Sci Date: 2021-03-22 Impact factor: 2.153