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

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...

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Published in:International journal of stroke 2023-02, Vol.18 (2), p.229-236
Main Authors: Olivé-Gadea, Marta, Pérez de la Ossa, Natalia, Jovin, Tudor, Abilleira, Sonia, Jiménez, Xavier, Cardona, Pere, Chamorro, Angel, Flores, Alan, Silva, Yolanda, Purroy, Francesc, Martí-Fabregas, Joan, Rodríguez-Campello, Ana, Zaragoza, Josep, Krupinski, Jerzy, Canovas, David, Gomez Choco, Manuel, Mas, Natalia, Palomeras, Ernest, Cocho, Dolores, Aragonès, Josep M, Repullo, Carmen, Sanjurjo, Eduard, Carrion, Dolores, Catena, Esther, Costa, Xavier, Almendros, M Cruz, Barceló, Miquel, Monedero, Jordi, Rybyeva, Maria, Diaz, Gloria, Ribó, Marc
Format: Article
Language:English
Subjects:
Brain Ischemia - therapy
Endovascular Procedures
Humans
Ischemic Stroke
Quality Indicators, Health Care
Retrospective Studies
Stroke - epidemiology
Stroke - therapy
Thrombectomy
Thrombolytic Therapy - methods
Treatment Outcome
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Summary: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 
ISSN:1747-4930
1747-4949
DOI:10.1177/17474930221093523