급성 허혈성 뇌졸중 환자의 병원간 이송 지연에 대한 도시화 수준의 영향

Abstract

Purpose: Inter-hospital transport poses a number of challengingissues, including prolonging the time interval fromsymptoms to optimal reperfusion therapy after ischemicstroke. It is unclear whether urbanization is associated withoutcomes of inter-hospital transfer including length of stayat the referring hospital (D1LOS). Methods: A prospective stroke registry from 23 EmergencyDepartments (ED) from 2007 to 2012 over the nation wascollected. Ischemic stroke patients who arrived at the firstED within 24 hours of onset (S2D1) were enrolled. Patientswere excluded if time intervals or address were incorrect ormissing. Main exposure was urbanization level; urban ≥10,000 and rural <10,000 population. Primary outcome wasD1LOS. The secondary outcomes were symptoms to doorof the first ED (S2D1) and transfer time to the final ED(T2D2). We compared the D1LOS, S2D1, and T2D2 withmedian and inter-quartile range (IQR) by urbanization level. Results: Of 5,909 patients transferred from other hospitals,2,289 patients were analyzed; 1,441 (63%) patients in urbanareas, 848 (37%) patients in rural areas were included. TheD1LOS and S2D1 in urban was longer than those in rural;100 minutes (IQR 50~208) for urban VS 82.5 minutes (IQR48~170.5) for rural (p=0.01) and 66 minutes (IQR 30~240)for urban VS 90 minutes (IQR 30~330) for rural (p=0.001). T2D2 in urban was shorter than that in rural; 54 minutes (IQR36~78), 40 minutes (IQR 25~65) (p≤0.00), respectively. Conclusion: Urban EDs showed longer D1LOS beforetransferring patients to the hospital for definite care. Strategy for reducing delay due to inter-hospital transportshould differ according to urbanization.