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. 2021 Jan 4;21(1):12.
doi: 10.1186/s12913-020-05982-0.

Short and long-term impact of four sets of actions on acute ischemic stroke management in Rhône County, a population based before-and-after prospective study

A M Schott  1   2 , A Termoz  3   4 , M Viprey  3   4 , K Tazarourte  3   5 , C Della Vecchia  3 , E Bravant  3   4 , N Perreton  4 , N Nighoghossian  6 , S Cakmak  7 , S Meyran  8 , B Ducreux  9 , C Pidoux  9 , T Bony  10 , M Douplat  10 , V Potinet  10 , A Sigal  11 , Y Xue  3   4 , L Derex  3   6 , J Haesebaert  3   4
Affiliations

Short and long-term impact of four sets of actions on acute ischemic stroke management in Rhône County, a population based before-and-after prospective study

A M Schott et al. BMC Health Serv Res. .

Abstract

Background: Optimizing access to recanalization therapies in acute ischemic stroke patients is crucial. Our aim was to measure the short and long term effectiveness, at the acute phase and 1 year after stroke, of four sets of actions implemented in the Rhône County.

Methods: The four multilevel actions were 1) increase in stroke units bed capacity and development of endovascular therapy; 2) improvement in knowledge and skills of healthcare providers involved in acute stroke management using a bottom-up approach; 3) development and implementation of new organizations (transportation routes, pre-notification, coordination by the emergency call center physician dispatcher); and 4) launch of regional public awareness campaigns in addition to national campaigns. A before-and-after study was conducted with two identical population-based cohort studies in 2006-7 and 2015-16 in all adult ischemic stroke patients admitted to any emergency department or stroke unit of the Rhône County. The primary outcome criterion was in-hospital management times, and the main secondary outcome criteria were access to reperfusion therapy (either intravenous thrombolysis or endovascular treatment) and pre-hospital management times in the short term, and 12-month prognosis measured by the modified Rankin Scale (mRS) in the long term.

Results: Between 2015-16 and 2006-7 periods ischemic stroke patients increased from 696 to 717, access to reperfusion therapy increased from 9 to 23% (p < 0.0001), calls to emergency call-center from 40 to 68% (p < 0.0001), first admission in stroke unit from 8 to 30% (p < 0.0001), and MRI within 24 h from 18 to 42% (p < 0.0001). Onset-to-reperfusion time significantly decreased from 3h16mn [2 h54-4 h05] to 2h35mn [2 h05-3 h19] (p < 0.0001), mainly related to a decrease in delay from admission to imaging. A significant decrease of disability was observed, as patients with mild disability (mRS [0-2]) at 12 months increased from 48 to 61% (p < 0.0001). Pre-hospital times, however, did not change significantly.

Conclusions: We observed significant improvement in access to reperfusion therapy, mainly through a strong decrease of in-hospital management times, and in 12-month disability after the implementation of four sets of actions between 2006 and 2016 in the Rhône County. Reducing pre-hospital times remains a challenge.

Keywords: Cohort study; Emergency medical services; Health services research; Ischemic stroke; Organization; Reperfusion therapy; Time-to-treatment.

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Conflict of interest statement

The authors declare no conflict of interest regarding this study.

Figures

Fig. 1
Fig. 1
Organization of acute stroke emergency care in France. legend: Thicker arrows represent the best theoretical pathways for most effective management as recommended by French guidelines. Abbreviations: SMUR, Service Mobile d’Urgence et de Réanimation (system of highly medicalized transportation)
Fig. 2
Fig. 2
Study flow chart
See this image and copyright information in PMC

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