Backgrounds - Thrombolytic therapy is the standard treatment for acute ischemic stroke, but there may be disparities across hospitals. 
Methods - This retrospective observational study was performed by analyzing the data of the patients admitted to 258 acute stroke care hospitals covering entire country from the Acute Stroke Quality Assessment Program from 2008 to 2014. Primary outcome was the recanalization therapy rate (RTR) in each hospital. RTR was the proportion of intravenous tPA (IVT) and/or endovascular thrombectomy (EVT) in potentially thrombectomy-eligible population, whose onset-to-arrival time less than 6 hours and initial NIHSS≥4 or GCS≤14. RTR was adjusted with age, sex, onset-to-arrival time and initial stroke severity. Adjusted RTR was compared according to several hospital characteristics.
Results – During the study period, 2,790 potentially thrombectomy-eligible patients were admitted to 174 hospitals in Korea for acute stroke care. Overall RTR was 47.2%, which was composed of IVT alone 39.3%, EVT alone 2.8% and combination 5.2%. Hospital characteristics including number of beds, average stroke admission per month, averaged IVT per month, presence of stroke unit and number of stroke neurologists were significantly associated with increased RTR with dose-responsive manners. Higher number of beds and average stroke admission per month were associated with higher adjusted RTR. (Spearman correlation coefficient = 0.42 and 0.43, p<.0001, separately)
Conclusion – Adequacy of thrombolytic therapy in acute ischemic stroke patients in Korea was associated with hospital characteristics, such as number of beds, average stroke admission per month, averaged IVT per month, presence of stroke unit and number of stroke neurologists.

Disparity across the hospitals in thrombolytic treatment of acute ischemic stroke: Korean Nationwide study