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Observational Study
. 2023 Feb;18(2):229-236.
doi: 10.1177/17474930221093523. Epub 2022 May 4.

Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population

Marta Olivé-Gadea  1 , Natalia Pérez de la Ossa  2 , Tudor Jovin  3 , Sonia Abilleira  4 , Xavier Jiménez  5 , Pere Cardona  6 , Angel Chamorro  7 , Alan Flores  8 , Yolanda Silva  9 , Francesc Purroy  10 , Joan Martí-Fabregas  11 , Ana Rodríguez-Campello  12 , Josep Zaragoza  13 , Jerzy Krupinski  14 , David Canovas  15 , Manuel Gomez Choco  16 , Natalia Mas  17 , Ernest Palomeras  18 , Dolores Cocho  19 , Josep M Aragonès  20 , Carmen Repullo  21 , Eduard Sanjurjo  22 , Dolores Carrion  23 , Esther Catena  24 , Xavier Costa  25 , M Cruz Almendros  26 , Miquel Barceló  27 , Jordi Monedero  28 , Maria Rybyeva  29 , Gloria Diaz  30 , Marc Ribó  1
Affiliations
Observational Study

Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population

Marta Olivé-Gadea et al. Int J Stroke. 2023 Feb.

Abstract

Background: Acute ischemic stroke patients not referred directly to a comprehensive stroke center (CSC) have reduced access to endovascular treatment (EVT). The RACECAT trial is a population-based cluster-randomized trial, designed to compare mothership and drip-and-ship strategies in acute ischemic stroke patients outside the catchment area of a CSC.

Aims: To analyze the evolution of performance indicators in the regions that participated in RACECAT.

Methods: This retrospective longitudinal observational study included all stroke alerts evaluated by emergency medical services in Catalonia between February 2016 and February 2020. Cases were classified geographically according to the nearest SC: local SC (Local-SC) and CSC catchment areas. We analyzed the evolution of EVT rates and relevant workflow times in Local-SC versus CSC catchment areas over three study periods: P1 (February 2016 to April 2017: before RACECAT initiation), P2 (May 2017 to September 2018), and P3 (October 2018 to February 2020).

Results: We included 20603 stroke alerts, 10,694 (51.9%) of which were activated within Local-SC catchment areas. The proportion of patients receiving EVT within Local-SC catchment areas increased (P1 vs. P3: 7.5% (95% confidence interval (CI), 6.4-8.7) to 22.5% (95% CI, 20.8-24.4) p < 0.001). Inequalities in the odds of receiving EVT were reduced for patients from CSC versus Local-SC catchment areas (P1: odds ratio (OR) 3.9 (95% CI, 3.2-5) vs. P3: OR 1.5 (95% CI, 1.3-1.7) In Local-SC, door-to-image (P1: 24 (interquartile range (IQR) 15-36), P2: 24 (15-35), P3: 21 (13-32) min, p < 0.001) and door-to-needle times (P1: 42 (31-60), P2: 41 (29-58), P3: 35 (25-50) p < 0.001) reduced. Time from Local-SC arrival to groin puncture also decreased over time (P1: 188 [151-229], P2: 190 (157-233), P3: 168 (127-215) min, p < 0.001).

Conclusion: An increase in EVT rates in Local-SC regions with a significant decrease in workflow times occurred during the period of the RACECAT trial.

Keywords: Stroke network; territorial disparities; workflow.

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