M. Kitzrow

Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy

Background: After thrombectomy has shown to be effective in acute stroke patients with large vessel occlusion, the potential benefit of secondary referral for such an intervention needs to be validated. Aims: We aimed to compare consecutive stoke patients directly admitted and treated with thrombectomy at a neurointerventional centre with patients secondarily referred for such a procedure from hospitals with a stroke unit. Methods: Periprocedure times and mortality in 300 patients primarily treated in eight neurointerventional centres were compared with 343 patients referred from nine other hospitals in a prospective multicentre study of a German neurovascular network. Data on functional outcome at 3 months was available in 430 (76.4%) patients. Results: In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality (21.9% versus 24.1%, p = 0.53) were not statistically different in both patient groups despite a significant shorter symptom to groin puncture time in directly admitted patients, which was mainly caused by a longer interfacility transfer time. We found a nonsignificant trend for better functional outcome at 3 months in directly admitted patients (modified Rankin Scale 0–2, 44.0% versus 35.7%, p = 0.08). Conclusions: Our results show that a drip-and-ship thrombectomy concept can be effectively organized in a metropolitan stroke network. Every effort should be made to speed up the emergency interfacility transfer to a neurointerventional centre in stroke patients eligible for thrombectomy after initial brain imaging.

Qualitätsparameter der akuten Schlaganfallversorgung

BACKGROUND The long-term prognosis of stroke patients is still dependent in particular on the timing of a correct diagnosis, immediate initiation of a suitable specific therapy and competent treatment in a stroke unit. Therefore, nationwide attempts are being made to establish a comprehensive coverage of the necessary specific competence and infrastructural requirements. Divergent regional circumstances and economic viewpoints determine the characteristics of the various healthcare concepts and the interplay between participating cooperation partners. This article compares the development with respect to three qualitative treatment parameters exemplified by four regional healthcare models during the time period 2008-2011. METHODS The hospitalization rates for patients with transitory ischemic attacks, ischemic and hemorrhagic stroke, the case numbers for stoke unit treatment and the rates of systemic thrombolysis and mechanical thrombectomy in the regions of Berlin, the Ruhr Area, Ostwestfalen-Lippe and southeast Bayern (TEMPiS) are presented based on the data from the DRG statistical reports for the years 2008 and 2011. RESULTS The average hospitalization rates for ischemic stroke patients (brain infarct ICD 163) in the time period from 2008 to 2011 were 294 per 100,000 inhabitants for the Ruhr Area, 257 per 100,000 inhabitants for Ostwestfalen-Lippe and 265 per 100,000 inhabitants each for Berlin and southeast Bayern. The complex stroke treatment quota for southeast Bayern in 2008 was 31 % and 47 % in 2011 and the respective quotas for the other regions studied were 42-44 % and 58-59 %. The rate of systemic thrombolysis in 2008 ranged between 4.2 % and 7.4 % and in 2011 the increase in the range for the 4 regions studied was between 41 % and 145 %. In 2011 the thrombectomy quota of 2 % in the Ruhr Area was the only one which was above the national average of 1.3 % of all brain infarcts. DISCUSSION Stroke is a common disease in the four regions studied. For the established forms of therapy, complex treatment of stroke and systemic thrombolysis, the positive effect of structurally improved approaches in the four different regional treatment concepts could be confirmed during the course of the observational time period selected. Mechanical thrombectomy which is currently still considered to be an individual healing attempt, was used significantly more often in the Ruhr Area in 2011 than in the other three regions studied. A standardized referral procedure had previously been established in the metropolitan regions.

Versorgungsrealität der Patienten mit ischämischem Schlaganfall im Ruhrgebiet

BACKGROUND Networking structures are constructed to improve daily care of acute stroke patients, in the Ruhr area by the association of 26 neurological departments. Quality of care can be measured by the rate of stroke unit treatment and of thrombolysis. Epidemiological data are mainly derived from registers resulting in sparse insight into incidence and rate of specialized care in daily practice. METHODS The study involved data analysis of diagnosis-related groups (DRG) statistics and structured quality reports for 2008 and 2010 for depiction of the quality of routine treatment. Aggregation of the number of cases for incidence, rate of stroke unit treatment and thrombolysis district, province, and nation wide were analyzed. RESULTS In 5.2 million inhabitants, the incidence of ischemic stroke (ICD I63) was 296/100,000 in 2010 (district-wise range 244-364) and 56% of patients were treated on a stroke unit (range 18-80%; 2008: 43%, range 10-72%). The rate of thrombolysis (ICD I63) was 6.4% and 9.1% in 2008 and 2010 (2008 range 0-11.2%, 2010 range 3.9-18.0%), respectively, which was significantly above the provincial average in 10 out of 15 districts. DISCUSSION Ischemic stroke is a common disease in the area and the quality of care (e.g. stroke unit treatment and thrombolysis rate) is above average. The heterogeneous character of the region allows an exemplary networking aiming for the improvement of routine patient care, e.g. by the implementation of homogeneous standards and structural measures for the implementation of novel therapies. The current analysis allows the identification of the potential for optimization and monitoring of any changes.

Stroke admission outside daytime working hours delays mechanical thrombectomy and worsens short-term outcome

Background and purpose Rapid therapeutic decisions in acute stroke patients leading to earlier initiation of revascularization therapies are associated with better outcome. An association between regular working hours and reduced time to initiation of intravenous thrombolysis has been reported. However, its influence on mechanical thrombectomy (MT) remains uncertain. We aimed to analyze the effects of admission time on door-to-groin time and stroke outcome in a large prospective stroke registry of the Neurovascular Net Ruhr in Germany. Methods Procedural times of a total of 512 patients treated with MT were analyzed. Admission to hospital during regular working days and hours (Monday to Friday, 8 am to 4 pm) was compared with admission outside these times. Door-to-groin time and the difference in NIH Stroke Scale between admission and discharge served as primary outcome parameters. Long-term functional outcome was centrally assessed with modified Rankin scale. Results MT outside regular working hours was associated with a significant mean initiation delay of 20 min. By multivariate regression analysis, every 20 min delay of MT reduced the difference in NIHSS score between admission and discharge by 0.76 points (95% CI −1.24 to −0.28, p = 0.002). Favorable long-term outcome did not differ between both treatment groups. Conclusions Treatment outside regular working hours caused a significant delay in the initiation of MT, which was associated with a decreased short-term clinical efficacy of thrombectomy. Strategies like compulsory attendance of the interventional neuroradiologist at the hospital 24/7 might result in shorter door-to-groin times and consecutive in better stroke outcome.

[Treatment reality of internal carotid artery stenosis in Germany : requirement and reality in international comparison and in light of the current S3 guidelines].

ZusammenfassungHintergrundHöhergradige atherosklerotisch bedingte extrakranielle Karotisstenosen sind für 5–10 % aller ischämischen Schlaganfälle verantwortlich. Die Empfehlungen insbesondere zur Versorgung asymptomatischer Stenosen unterziehen sich aktuell einem Wandel. Gesammelte Erkenntnisse zu Indikationsstellung und Verteilung von Fallzahlen in Deutschland liegen nicht vor. Ebenso sind diesbezüglich weder Einfluss noch Umsetzung der im Jahr 2012 publizierten S3-Leitlinie untersucht.MethodeRoutineversorgungsdaten wurden anhand der DRG („diagnosis-related groups“) -Statistiken und strukturierter Qualitätsberichte der Krankenhäuser zur Häufigkeit operativer und interventioneller endovaskulärer Eingriffe an symptomatischen und asymptomatischen Karotisstenosen in den Jahren 2010 und 2013 ausgewertet.ErgebnissePro Jahr werden in Deutschland ca. 37.000 Karotisendarteriektomien (CEA) und 5000 Karotisangioplastien mit Stentversorgung (CAS) durchgeführt. Etwa 94 % der CEA und 62 % der CAS werden in Zentren mit > 25 Eingriffen pro Jahr durchgeführt. Lediglich 33 % der CEA und 39 % der CAS werden bei symptomatischen Stenosen vorgenommen.SchlussfolgerungRechnerisch zeigen sich eine Unterversorgung von symptomatischen und eine Überversorgung von asymptomatischen Karotisstenosen. Es sollten Anstrengungen unternommen werden, um eine leitlinienkonformere Versorgung herzustellen und damit insbesondere das Schlaganfallrisiko beim Vorliegen einer atherosklerotischen symptomatischen Arteria-carotis-interna-Stenose zu reduzieren.SummaryBackgroundSevere atherosclerotic extracranial carotid artery stenosis accounts for 5–10 % of all ischemic strokes. Currently, therapeutic recommendations are undergoing changes, particularly regarding the treatment of asymptomatic stenosis. Consolidated knowledge on the indications, nationwide distribution and numbers of cases are not available. Moreover, the impact and grade of implementation of the recently published national S3 guidelines on the reality of medical treatment remain unclear.MethodsAnalysis of administrative hospital data involving the diagnosis-related groups (DRG) statistics and structured quality reports for 2010 and 2013 to evaluate the procedural therapy trends concerning operative and interventional approaches for symptomatic and asymptomatic carotid artery stenoses.ResultsIn Germany approximately 37,000 carotid endarterectomies (CEA) and approximately 5,000 carotid angioplasties with stenting (CAS) are carried out per year. Approximately 94 % of CEA and 62 % of CAS are performed in centers with more than 25 procedures per year. Only 33 % of CEA and 39 % of CAS are related to symptomatic stenosis.ConclusionMathematically, an undertreatment of symptomatic and an overtreatment of asymptomatic carotid artery stenoses become apparent. Efforts should be made to achieve inpatient medical treatment conforming to the national S3 guidelines, in particular to adequately reduce the risk of stroke recurrence in patients with atherosclerotic symptomatic carotid artery stenosis.BACKGROUND Severe atherosclerotic extracranial carotid artery stenosis accounts for 5-10 % of all ischemic strokes. Currently, therapeutic recommendations are undergoing changes, particularly regarding the treatment of asymptomatic stenosis. Consolidated knowledge on the indications, nationwide distribution and numbers of cases are not available. Moreover, the impact and grade of implementation of the recently published national S3 guidelines on the reality of medical treatment remain unclear. METHODS Analysis of administrative hospital data involving the diagnosis-related groups (DRG) statistics and structured quality reports for 2010 and 2013 to evaluate the procedural therapy trends concerning operative and interventional approaches for symptomatic and asymptomatic carotid artery stenoses. RESULTS In Germany approximately 37,000 carotid endarterectomies (CEA) and approximately 5,000 carotid angioplasties with stenting (CAS) are carried out per year. Approximately 94 % of CEA and 62 % of CAS are performed in centers with more than 25 procedures per year. Only 33 % of CEA and 39 % of CAS are related to symptomatic stenosis. CONCLUSION Mathematically, an undertreatment of symptomatic and an overtreatment of asymptomatic carotid artery stenoses become apparent. Efforts should be made to achieve inpatient medical treatment conforming to the national S3 guidelines, in particular to adequately reduce the risk of stroke recurrence in patients with atherosclerotic symptomatic carotid artery stenosis.

Versorgungsrealität von Karotisstenosen in Deutschland@@@Treatment reality of internal carotid artery stenosis in Germany: Forderung und Wirklichkeit im internationalen Vergleich und im Lichte der aktuellen S3-Leitlinie@@@Requirement and reality in international comparison and in light of the current S3 guidelines

ZusammenfassungHintergrundHöhergradige atherosklerotisch bedingte extrakranielle Karotisstenosen sind für 5–10 % aller ischämischen Schlaganfälle verantwortlich. Die Empfehlungen insbesondere zur Versorgung asymptomatischer Stenosen unterziehen sich aktuell einem Wandel. Gesammelte Erkenntnisse zu Indikationsstellung und Verteilung von Fallzahlen in Deutschland liegen nicht vor. Ebenso sind diesbezüglich weder Einfluss noch Umsetzung der im Jahr 2012 publizierten S3-Leitlinie untersucht.MethodeRoutineversorgungsdaten wurden anhand der DRG („diagnosis-related groups“) -Statistiken und strukturierter Qualitätsberichte der Krankenhäuser zur Häufigkeit operativer und interventioneller endovaskulärer Eingriffe an symptomatischen und asymptomatischen Karotisstenosen in den Jahren 2010 und 2013 ausgewertet.ErgebnissePro Jahr werden in Deutschland ca. 37.000 Karotisendarteriektomien (CEA) und 5000 Karotisangioplastien mit Stentversorgung (CAS) durchgeführt. Etwa 94 % der CEA und 62 % der CAS werden in Zentren mit > 25 Eingriffen pro Jahr durchgeführt. Lediglich 33 % der CEA und 39 % der CAS werden bei symptomatischen Stenosen vorgenommen.SchlussfolgerungRechnerisch zeigen sich eine Unterversorgung von symptomatischen und eine Überversorgung von asymptomatischen Karotisstenosen. Es sollten Anstrengungen unternommen werden, um eine leitlinienkonformere Versorgung herzustellen und damit insbesondere das Schlaganfallrisiko beim Vorliegen einer atherosklerotischen symptomatischen Arteria-carotis-interna-Stenose zu reduzieren.SummaryBackgroundSevere atherosclerotic extracranial carotid artery stenosis accounts for 5–10 % of all ischemic strokes. Currently, therapeutic recommendations are undergoing changes, particularly regarding the treatment of asymptomatic stenosis. Consolidated knowledge on the indications, nationwide distribution and numbers of cases are not available. Moreover, the impact and grade of implementation of the recently published national S3 guidelines on the reality of medical treatment remain unclear.MethodsAnalysis of administrative hospital data involving the diagnosis-related groups (DRG) statistics and structured quality reports for 2010 and 2013 to evaluate the procedural therapy trends concerning operative and interventional approaches for symptomatic and asymptomatic carotid artery stenoses.ResultsIn Germany approximately 37,000 carotid endarterectomies (CEA) and approximately 5,000 carotid angioplasties with stenting (CAS) are carried out per year. Approximately 94 % of CEA and 62 % of CAS are performed in centers with more than 25 procedures per year. Only 33 % of CEA and 39 % of CAS are related to symptomatic stenosis.ConclusionMathematically, an undertreatment of symptomatic and an overtreatment of asymptomatic carotid artery stenoses become apparent. Efforts should be made to achieve inpatient medical treatment conforming to the national S3 guidelines, in particular to adequately reduce the risk of stroke recurrence in patients with atherosclerotic symptomatic carotid artery stenosis.BACKGROUND Severe atherosclerotic extracranial carotid artery stenosis accounts for 5-10 % of all ischemic strokes. Currently, therapeutic recommendations are undergoing changes, particularly regarding the treatment of asymptomatic stenosis. Consolidated knowledge on the indications, nationwide distribution and numbers of cases are not available. Moreover, the impact and grade of implementation of the recently published national S3 guidelines on the reality of medical treatment remain unclear. METHODS Analysis of administrative hospital data involving the diagnosis-related groups (DRG) statistics and structured quality reports for 2010 and 2013 to evaluate the procedural therapy trends concerning operative and interventional approaches for symptomatic and asymptomatic carotid artery stenoses. RESULTS In Germany approximately 37,000 carotid endarterectomies (CEA) and approximately 5,000 carotid angioplasties with stenting (CAS) are carried out per year. Approximately 94 % of CEA and 62 % of CAS are performed in centers with more than 25 procedures per year. Only 33 % of CEA and 39 % of CAS are related to symptomatic stenosis. CONCLUSION Mathematically, an undertreatment of symptomatic and an overtreatment of asymptomatic carotid artery stenoses become apparent. Efforts should be made to achieve inpatient medical treatment conforming to the national S3 guidelines, in particular to adequately reduce the risk of stroke recurrence in patients with atherosclerotic symptomatic carotid artery stenosis.

Versorgungsrealität von Karotisstenosen in Deutschland

ZusammenfassungHintergrundHöhergradige atherosklerotisch bedingte extrakranielle Karotisstenosen sind für 5–10 % aller ischämischen Schlaganfälle verantwortlich. Die Empfehlungen insbesondere zur Versorgung asymptomatischer Stenosen unterziehen sich aktuell einem Wandel. Gesammelte Erkenntnisse zu Indikationsstellung und Verteilung von Fallzahlen in Deutschland liegen nicht vor. Ebenso sind diesbezüglich weder Einfluss noch Umsetzung der im Jahr 2012 publizierten S3-Leitlinie untersucht.MethodeRoutineversorgungsdaten wurden anhand der DRG („diagnosis-related groups“) -Statistiken und strukturierter Qualitätsberichte der Krankenhäuser zur Häufigkeit operativer und interventioneller endovaskulärer Eingriffe an symptomatischen und asymptomatischen Karotisstenosen in den Jahren 2010 und 2013 ausgewertet.ErgebnissePro Jahr werden in Deutschland ca. 37.000 Karotisendarteriektomien (CEA) und 5000 Karotisangioplastien mit Stentversorgung (CAS) durchgeführt. Etwa 94 % der CEA und 62 % der CAS werden in Zentren mit > 25 Eingriffen pro Jahr durchgeführt. Lediglich 33 % der CEA und 39 % der CAS werden bei symptomatischen Stenosen vorgenommen.SchlussfolgerungRechnerisch zeigen sich eine Unterversorgung von symptomatischen und eine Überversorgung von asymptomatischen Karotisstenosen. Es sollten Anstrengungen unternommen werden, um eine leitlinienkonformere Versorgung herzustellen und damit insbesondere das Schlaganfallrisiko beim Vorliegen einer atherosklerotischen symptomatischen Arteria-carotis-interna-Stenose zu reduzieren.SummaryBackgroundSevere atherosclerotic extracranial carotid artery stenosis accounts for 5–10 % of all ischemic strokes. Currently, therapeutic recommendations are undergoing changes, particularly regarding the treatment of asymptomatic stenosis. Consolidated knowledge on the indications, nationwide distribution and numbers of cases are not available. Moreover, the impact and grade of implementation of the recently published national S3 guidelines on the reality of medical treatment remain unclear.MethodsAnalysis of administrative hospital data involving the diagnosis-related groups (DRG) statistics and structured quality reports for 2010 and 2013 to evaluate the procedural therapy trends concerning operative and interventional approaches for symptomatic and asymptomatic carotid artery stenoses.ResultsIn Germany approximately 37,000 carotid endarterectomies (CEA) and approximately 5,000 carotid angioplasties with stenting (CAS) are carried out per year. Approximately 94 % of CEA and 62 % of CAS are performed in centers with more than 25 procedures per year. Only 33 % of CEA and 39 % of CAS are related to symptomatic stenosis.ConclusionMathematically, an undertreatment of symptomatic and an overtreatment of asymptomatic carotid artery stenoses become apparent. Efforts should be made to achieve inpatient medical treatment conforming to the national S3 guidelines, in particular to adequately reduce the risk of stroke recurrence in patients with atherosclerotic symptomatic carotid artery stenosis.BACKGROUND Severe atherosclerotic extracranial carotid artery stenosis accounts for 5-10 % of all ischemic strokes. Currently, therapeutic recommendations are undergoing changes, particularly regarding the treatment of asymptomatic stenosis. Consolidated knowledge on the indications, nationwide distribution and numbers of cases are not available. Moreover, the impact and grade of implementation of the recently published national S3 guidelines on the reality of medical treatment remain unclear. METHODS Analysis of administrative hospital data involving the diagnosis-related groups (DRG) statistics and structured quality reports for 2010 and 2013 to evaluate the procedural therapy trends concerning operative and interventional approaches for symptomatic and asymptomatic carotid artery stenoses. RESULTS In Germany approximately 37,000 carotid endarterectomies (CEA) and approximately 5,000 carotid angioplasties with stenting (CAS) are carried out per year. Approximately 94 % of CEA and 62 % of CAS are performed in centers with more than 25 procedures per year. Only 33 % of CEA and 39 % of CAS are related to symptomatic stenosis. CONCLUSION Mathematically, an undertreatment of symptomatic and an overtreatment of asymptomatic carotid artery stenoses become apparent. Efforts should be made to achieve inpatient medical treatment conforming to the national S3 guidelines, in particular to adequately reduce the risk of stroke recurrence in patients with atherosclerotic symptomatic carotid artery stenosis.

Qualitätsparameter der akuten Schlaganfallversorgung@@@Quality parameters in the treatment of acute stroke: Gegenüberstellung unterschiedlicher regionaler Versorgungskonzepte@@@Comparison of various regional treatment concepts

BACKGROUND The long-term prognosis of stroke patients is still dependent in particular on the timing of a correct diagnosis, immediate initiation of a suitable specific therapy and competent treatment in a stroke unit. Therefore, nationwide attempts are being made to establish a comprehensive coverage of the necessary specific competence and infrastructural requirements. Divergent regional circumstances and economic viewpoints determine the characteristics of the various healthcare concepts and the interplay between participating cooperation partners. This article compares the development with respect to three qualitative treatment parameters exemplified by four regional healthcare models during the time period 2008-2011. METHODS The hospitalization rates for patients with transitory ischemic attacks, ischemic and hemorrhagic stroke, the case numbers for stoke unit treatment and the rates of systemic thrombolysis and mechanical thrombectomy in the regions of Berlin, the Ruhr Area, Ostwestfalen-Lippe and southeast Bayern (TEMPiS) are presented based on the data from the DRG statistical reports for the years 2008 and 2011. RESULTS The average hospitalization rates for ischemic stroke patients (brain infarct ICD 163) in the time period from 2008 to 2011 were 294 per 100,000 inhabitants for the Ruhr Area, 257 per 100,000 inhabitants for Ostwestfalen-Lippe and 265 per 100,000 inhabitants each for Berlin and southeast Bayern. The complex stroke treatment quota for southeast Bayern in 2008 was 31 % and 47 % in 2011 and the respective quotas for the other regions studied were 42-44 % and 58-59 %. The rate of systemic thrombolysis in 2008 ranged between 4.2 % and 7.4 % and in 2011 the increase in the range for the 4 regions studied was between 41 % and 145 %. In 2011 the thrombectomy quota of 2 % in the Ruhr Area was the only one which was above the national average of 1.3 % of all brain infarcts. DISCUSSION Stroke is a common disease in the four regions studied. For the established forms of therapy, complex treatment of stroke and systemic thrombolysis, the positive effect of structurally improved approaches in the four different regional treatment concepts could be confirmed during the course of the observational time period selected. Mechanical thrombectomy which is currently still considered to be an individual healing attempt, was used significantly more often in the Ruhr Area in 2011 than in the other three regions studied. A standardized referral procedure had previously been established in the metropolitan regions.

[Quality parameters in the treatment of acute stroke: comparison of various regional treatment concepts].

BACKGROUND The long-term prognosis of stroke patients is still dependent in particular on the timing of a correct diagnosis, immediate initiation of a suitable specific therapy and competent treatment in a stroke unit. Therefore, nationwide attempts are being made to establish a comprehensive coverage of the necessary specific competence and infrastructural requirements. Divergent regional circumstances and economic viewpoints determine the characteristics of the various healthcare concepts and the interplay between participating cooperation partners. This article compares the development with respect to three qualitative treatment parameters exemplified by four regional healthcare models during the time period 2008-2011. METHODS The hospitalization rates for patients with transitory ischemic attacks, ischemic and hemorrhagic stroke, the case numbers for stoke unit treatment and the rates of systemic thrombolysis and mechanical thrombectomy in the regions of Berlin, the Ruhr Area, Ostwestfalen-Lippe and southeast Bayern (TEMPiS) are presented based on the data from the DRG statistical reports for the years 2008 and 2011. RESULTS The average hospitalization rates for ischemic stroke patients (brain infarct ICD 163) in the time period from 2008 to 2011 were 294 per 100,000 inhabitants for the Ruhr Area, 257 per 100,000 inhabitants for Ostwestfalen-Lippe and 265 per 100,000 inhabitants each for Berlin and southeast Bayern. The complex stroke treatment quota for southeast Bayern in 2008 was 31 % and 47 % in 2011 and the respective quotas for the other regions studied were 42-44 % and 58-59 %. The rate of systemic thrombolysis in 2008 ranged between 4.2 % and 7.4 % and in 2011 the increase in the range for the 4 regions studied was between 41 % and 145 %. In 2011 the thrombectomy quota of 2 % in the Ruhr Area was the only one which was above the national average of 1.3 % of all brain infarcts. DISCUSSION Stroke is a common disease in the four regions studied. For the established forms of therapy, complex treatment of stroke and systemic thrombolysis, the positive effect of structurally improved approaches in the four different regional treatment concepts could be confirmed during the course of the observational time period selected. Mechanical thrombectomy which is currently still considered to be an individual healing attempt, was used significantly more often in the Ruhr Area in 2011 than in the other three regions studied. A standardized referral procedure had previously been established in the metropolitan regions.

Versorgungsrealität der Patienten mit ischämischem Schlaganfall im Ruhrgebiet@@@Reality of acute stroke patient care in the metropolitan Ruhr area: Aktueller Stand und Perspektiven einer fachspezifischen Vernetzung@@@Status quo and perspectives of a stroke-specific network

BACKGROUND Networking structures are constructed to improve daily care of acute stroke patients, in the Ruhr area by the association of 26 neurological departments. Quality of care can be measured by the rate of stroke unit treatment and of thrombolysis. Epidemiological data are mainly derived from registers resulting in sparse insight into incidence and rate of specialized care in daily practice. METHODS The study involved data analysis of diagnosis-related groups (DRG) statistics and structured quality reports for 2008 and 2010 for depiction of the quality of routine treatment. Aggregation of the number of cases for incidence, rate of stroke unit treatment and thrombolysis district, province, and nation wide were analyzed. RESULTS In 5.2 million inhabitants, the incidence of ischemic stroke (ICD I63) was 296/100,000 in 2010 (district-wise range 244-364) and 56% of patients were treated on a stroke unit (range 18-80%; 2008: 43%, range 10-72%). The rate of thrombolysis (ICD I63) was 6.4% and 9.1% in 2008 and 2010 (2008 range 0-11.2%, 2010 range 3.9-18.0%), respectively, which was significantly above the provincial average in 10 out of 15 districts. DISCUSSION Ischemic stroke is a common disease in the area and the quality of care (e.g. stroke unit treatment and thrombolysis rate) is above average. The heterogeneous character of the region allows an exemplary networking aiming for the improvement of routine patient care, e.g. by the implementation of homogeneous standards and structural measures for the implementation of novel therapies. The current analysis allows the identification of the potential for optimization and monitoring of any changes.