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임창덕 ( Chang Duk Lim ),류현욱 ( Hyun Wook Ryoo ),황양하 ( Yang Ha Hwang ),이미진 ( Mi Jin Lee ),신수정 ( Su Jeong Shin,),안재윤 ( Jae Yun Ahn ),김종근 ( Jong Kun Kim ),박정배 ( Jung Bae Park ),서강석 ( Kang Suk Seo ) 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.6
Purpose: The aim of this study was to compare the difference in acute stroke management between urban and rural areas, to investigate the factors affecting these differences, and to acquire basic information for establishing an efficient regional hub and spoke system for stroke patients. Methods: This retrospective study was based on adult patients diagnosed with acute ischemic stroke from January 2012 to December 2012 at a regional cerebrovascular center. The term “acute” was defined as 24 hours from symptom recognized. The term “urban” was defined as the region within the boundary of a metropolitan area. The distance from the symptom onset location to the stroke center was calculated using a global positioning system. Results: The rate of arriving at a stroke center within 3 hours after stroke recognition for acute ischemic stroke patients was much higher in urban areas compared to rural areas (27.5 vs. 19.2%, respectively; p-value=0.011). In stroke cases in rural areas, the distance from symptom onset location to a stroke center was determined as statistically significant through multivariate logistic regression analysis (Odds ratio (OR), 0.982; 95% Confidence interval (CI) 0.969-0.995). In contrast, the use of a public ambulance (OR, 4.258; 95% CI 2.233-8.118) and inter-hospital transfer (OR, 0.416; 95% CI 0.216-0.800) were the main prehospital delay factors in urban areas. Conclusion: For stroke cases in urban areas, it was important to directly visit a stroke center without transfer using a public ambulance. For rural areas, a new hub hospital and policies are necessary for reducing prehospital delay.