TY - JOUR
T1 - Evolution of quality indicators in acute stroke during the RACECAT Trial
T2 - Impact in the general population
AU - Olivé-Gadea, Marta
AU - Pérez de la Ossa, Natalia
AU - Jovin, Tudor
AU - Abilleira, Sonia
AU - Jiménez, Xavier
AU - Cardona, Pere
AU - Chamorro, Angel
AU - Flores, Alan
AU - Silva, Yolanda
AU - Purroy, Francesc
AU - Martí-Fabregas, Joan
AU - Rodríguez-Campello, Ana
AU - Zaragoza, Josep
AU - Krupinski, Jerzy
AU - Canovas, David
AU - Gomez Choco, Manuel
AU - Mas, Natalia
AU - Palomeras, Ernest
AU - Cocho, Dolores
AU - Aragonès, Josep M.
AU - Repullo, Carmen
AU - Sanjurjo, Eduard
AU - Carrion, Dolores
AU - Catena, Esther
AU - Costa, Xavier
AU - Almendros, M. Cruz
AU - Barceló, Miquel
AU - Monedero, Jordi
AU - Rybyeva, Maria
AU - Diaz, Gloria
AU - Ribó, Marc
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: N.P.O. reports grants from Project SLT008/18/0007, PERIS program from the Catalan Health Government.
Publisher Copyright:
© 2022 World Stroke Organization.
PY - 2022/4/4
Y1 - 2022/4/4
N2 - 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.
AB - 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.
KW - Stroke network
KW - territorial disparities
KW - workflow
UR - http://www.scopus.com/inward/record.url?scp=85132620998&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/4e235163-9afa-31f2-ade0-433d293cd4d4/
U2 - 10.1177/17474930221093523
DO - 10.1177/17474930221093523
M3 - Article
C2 - 35373657
AN - SCOPUS:85132620998
SP - 17474930221093523
JO - International Journal of Stroke
JF - International Journal of Stroke
SN - 1747-4930
ER -