J Korean Med Sci.  2020 May;35(20):e167. 10.3346/jkms.2020.35.e167.

Acute Stroke Care in Korea in 2013–2014: National Averages and Disparities

Affiliations
  • 1Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 2Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
  • 3Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
  • 4Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
  • 5Department of Neurology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
  • 6Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
  • 7Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 8Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
  • 9Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
  • 10Health Insurance Review and Assessment Service, Wonju, Korea

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.

Keyword

Stroke; Epidemiology; Cerebral Infarction; Cerebral Hemorrhage; Subarachnoid Hemorrhage
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