Assessment of Geographic Variations regarding the Transportation of Stroke Patients in Korea

Abstract

Introduction Stroke recently became the second cause of death in Korea. Nevertheless, many studies have reported that the delay of emergency medical service (EMS) transportation in specific areas is a major obstacle to reduce the mortality and morbidity of stroke. The objective of this study was to assess geographic variation regarding this factor at the national level in Korea throughout a funnel plot. Setting Emergency departments. Methods Data were obtained from the “2010 Emergency Medicine Annual Report” published by the National Emergency Medical Centre of Korea. This report describes the general characteristics of eligible Emergency Departments (EDs) across Korea. Therefore, we were able to calculate retrospectively the percentage of stroke patients who reached an ED within 3 hours after the development of symptoms against the volume of total visiting patients according to area. Subsequently, we generated a correlation matrix between ratio of stroke patients who visited EDs within the therapeutic period and ratio of usage of EMS ambulances. Results We found that four areas out of 16 administrative divisions in Korea were located beyond the lower control limit and one area was between the lower warning and lower control limits, according to a funnel plot showing the percentage of patients within the therapeutic period of stroke against the total volume of patients according to area. The ratio of stroke patients who visited EDs within the therapeutic period was significantly correlated with the ratio of use of EMS ambulances to a moderately positive degree (r=0.51; p<0.05). Conclusions Encouraging the public in Korea to use an EMS ambulance in case of stroke may shorten the pre-hospital delay.