Original Research

Significant delay and decreased chance of treatment for acute ischemic stroke patients on remote outer islets of China compared with the main island: the PUTUO Study


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Bangbo Xia
1 Doctor, Research Fellow

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Ning Liu
2 Doctor

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Li Hu
3 Bachelor, Vice Chief of Emergency Department

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Hongyi Zhu
4 Bachelor

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Bifeng Zhong
5 Bachelor, Chief of Neurology Department

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Zhongheng Zhang
6 Doctor

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Jian Lin
7 Bachelor, Chief of Information Department

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Yong Kang
8 Bachelor, Fellowship *


1, 2, 6 Emergency Department, SRRSH Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China

3 No.19 Road Wenkang

4, 8 Emergency Department, Zhejiang Putuo Hosiptal, Putuo District, Zhoushan, Zhejiang Province, China

5 Neurology Department, Zhejiang Putuo Hosiptal, Putuo District, Zhoushan, Zhejiang Province, China

7 Zhejiang Putuo Hosiptal, Putuo District, Zhoushan, Zhejiang Province, China

ACCEPTED: 13 January 2023

early abstract:

Background: Data from the acute ischemic stroke patients throughout 2021 from one district of an archipelago city of China were collected and analyzed retrospectively to unveil the management difference due to the time lags from the onset of the symptoms to the arrival at MI stroke center (FMCT)of two regions: main island (MI) and outer islets (OI).
Methods: All the patients’ information from 2021.1.1 to 2021.12.31 was retrieved through the electronic medical records system of the only stroke center located in MI. Then after screening and exclusion, every patient’s medical record was reviewed by two neurologists separately; as to the OI group’s patients, the actual addresses when onset of the stroke were confirmed by telephone to distinguish which group to enroll into. Comparisons were analyzed between the two regions from the gender, age, prior-to-stroke risk factors to peri-management parameters.
Results: 326 patients met the inclusion criteria: MI group 300; OI group 26. The gender, age and most of the risk factors showed no significant difference. FMCT were proved significantly distinct (p<0.001). The hospitalization expenses were also significantly different. The odd ratio of the definite treatment intravenous thrombolysis is 0.131(OI group to MI group, range: 0.017–0.987, p=0.021<p=0.05).
Conclusions: The diagnosis and treatment of acute ischemic stroke patients from OI was significant postponed when comparing with those from MI. The OI group population suffered much more from the acute ischemic stroke. Therefore, new effective and efficient solutions were in great need to carry out.