Effectiveness of regionalized systems for stroke and myocardial infarction

摘要: Background Acute ischemic stroke (AIS) and ST-segment elevation myocardial infarction (STEMI) are emergencies. Guidelines recommend care delivery within formally regionalized systems of at designated centers, with bypass nearby centers lesser or no designation. We review the evidence effectiveness in AIS STEMI. Methods Literature was searched using terms corresponding to designation STEMI from 2010 present. Inclusion criteria included report an outcome on any dependent variable mentioned rationale for regionalization guidelines independent comparing a non- pre-regionalized system. Designation defined case as certification by Joint Commission either primary (PSC) comprehensive (CSC) center. In case, search conducted linking “regionalization” “myocardial infarction” citation model system American Heart Association statement. Results For AIS, 17 publications met these were selected review. four criteria; therefore expanded relaxing include historical anecdotal comparison pre- nonregionalized state. The final yield nine papers six systems. Conclusion Although results enhanced process reduced unadjusted rates disparity access adverse outcomes, differences tend become nonsignificant when adjusted delayed presentation hospital arrival means other than emergency medical services. benefits occur along temporal trend improvement due uptake quality initiatives guideline recommendations all regardless Further research is justified randomized registry cluster design support refute that should be standard care.