A cluster randomized controlled trial will be conducted. Hospitals in Zhejiang Province, China, will be randomized into two arms (1:1): an intervention arm and a control arm. Hospitals in the intervention arm will receive a multilevel intervention based on the AACTT theory, whereas hospitals in the control arm will receive no intervention and maintain routine care. All the hospitals will receive electronic monitoring. Hospitals with no stroke center or with \<20 cases received thrombolysis per year will be excluded from the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
2,720
Multilevel intervention based on AACTT theory
Second Affiliated Hospital, School of Medicine, Zhejiang University
Hangzhou, Zhejiang, China
RECRUITINGThrombolysis rate within 4.5 hours
The proportion of acute ischemic stroke patients within 4.5 hours of onset
Time frame: Up to 4.5 hours
Thrombolysis rate within 3 hours
The proportion of acute ischemic stroke patients within 3 hours of onset
Time frame: Up to 3 hours
Excellent neurological outcomes
Score of 0 to 1 on the modified Rankin Scale, on which scores range from 0 (no neurologic deficit) to 6 (death)
Time frame: At 90 days
Favorable neurological outcomes
Score of 0 to 1 on the modified Rankin Scale, on which scores range from 0 (no neurologic deficit) to 6 (death)
Time frame: At 90 days
modified Rankin Scale score
The distribution of modified Rankin Scale score at 90 days, on which scores range from 0 (no neurologic deficit) to 6 (death)
Time frame: At 90 days
All-cause death rate
All-cause death rate at 90 days
Time frame: At 90 days
Hemorrhagic transformation
the presence of hemorrhagic transformation is defined according to European Cooperative Acute Stroke Study (ECASS) II trial
Time frame: At 7 days
Symptomatic intracranial hemorrhage
Intracranial hemorrhage at 24 hours associated with an increase of ≥4 points of NIHSS score from baseline, according to European Cooperative Acute Stroke Study (ECASS) II trial
Time frame: At 7 days
Door-to-image time
The time between hospital arrival and the initiation of image
Time frame: Up to 4.5 hours
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