Analysis of the current status and efficacy of acute ischemic stroke treatment based on hierarchical medical service network

doi:10.3969/j.issn.1006-7795.2025.01.007

Abstract

Abstract: Objective To analyze the current status of stroke treatment in the hierarchical medical service network and the impact of referral on prognosis, to optimize the stroke treatment models, and to improve stroke treatment efficiency. Methods Totally 573 patients with acute ischemic stroke who were referred by the hierarchical medical service network in Lishui, Zhejiang Province from January 2020 to December 2022 were selected for analysis of treatment and clinical data. Based on whether they received endovascular treatment at a high-level stroke center, they were divided into an effective referral group (261 cases) and an ineffective referral group (312 cases). Demographic data, influencing factors, clinical characteristics, and laboratory tests were compared between the two groups, and the differences were analyzed by using single-factor analysis, and prognosis of the two groups of patients was assessed. Results Among 573 patients,197 received intravenous thrombolytic therapy and 261 received intravascular therapy. The effective referral rate was 45.55%. The proportion of patients in the effective referral group coronary artery disease and atrial fibrillation proportion is higher（χ²=5.34,8.67，P＜0.05), more likely to show dysarthria, gaze, and consciousness disorder（χ²=130.1,22.12,22.96，P ＜0.05), and the baseline NIHSS score was higher (F =3.25，P ＜0.05). Comparing the baseline blood cells counts of the two groups of patients at admission, the effective referral group showed lower eosinophil count, basophil count and lymphocyte (Z=－8.86,－5.39,F=0.598，P ＜0.05). As for the prognosis, the proportion of neurological function improvement at discharge in the effective referral group was higher than that in the ineffective referral group. Binary Logistic regression analysis showed that baseline NIHSS score (OR=1.122, 95% CI:1.074-1.172), eosinophil (OR=0.085, 95% CI:0.013-0.564), and neutrophil count (OR=1.088, 95% CI:1.011-1.172) were independent influencing factors for effective referrals. Conclusions The efficiency of the current regional stroke classification and treatment network needs to be further improved. Developing predictive models that include demographic characteristics, risk factors, symptoms, signs, and laboratory tests may help medical staff in stroke prevention and treatment centers quickly identify large vessel occlusion and improve acute ischemic stroke treatment efficiency.

Key words: acute ischemic stroke, hierarchical medical system, large vessel occlusion

CLC Number:

R743.3

Zhan Yanli, Li Yiyin, Li Ping, Sun Jingping, Huang Liangtong, Cai Xueli. Analysis of the current status and efficacy of acute ischemic stroke treatment based on hierarchical medical service network[J]. Journal of Capital Medical University, 2025, 46(1): 41-47.

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