European Stroke Facilities Survey: The German and Austrian Perspective

Abstract

Background: The aim of this nested analysis was to identify the major components of stroke centers and other facilities actually available for acute stroke patients in hospitals of Germany and Austria. Methods: This analysis is part of a much larger European Stroke Facility Survey of 886 hospitals treating stroke patients all over Europe initiated by the European Stroke Initiative. Three levels of stroke care were predefined: comprehensive stroke centers (CSC), primary stroke centers (PSC) and a minimum level required for any hospital ward (AHW) admitting stroke patients. Hospitals providing even less than that were indicated in the ‘none’ category. Results: The present survey was conducted in 178 (166 and 12) German and Austrian hospitals which returned the questionnaire (41% response rate). They treated a total of 54,257 acute stroke patients per year (25% of all strokes in Germany and Austria), with a mean of 376 patients per year per hospital. 2,168 patients were given recombinant tissue plasminogen activator (4.7%), a proportion much higher than the pan-European average, but strongly dependent on the level of the facility considered (range 7.5–1.3%). Criteria for CSC were met in 13 hospitals (7.3%), for PSC in 15 (8.4%) and for AHW in 85 (47.7%). The minimum level required for AHW was not met in 65 hospitals (36.5%). 15.7% of German and Austrian hospitals provide stroke center facilities at the CSC or PSC level, as compared with 8.5% in Europe. A 24-hour availability of a stroke-trained physician was met by 100% of CSC, 73% of PSC, 85% of AHW and by 62% at the ‘none’ level of care. At the levels of CSC and PSC, a 100% availability was achieved for multidisciplinary stroke team, stroke-trained nurses, in-house emergency department, physiotherapy and speech therapy within 2 days, 24-hour brain CT and CT or MR angiography, as well as for transesophageal echocardiography and automated 24-hour monitoring of vital parameters. Nearly all these hospitals had training programs, stroke pathways, thrombolysis protocols and prevention procedures in place for the acute care of stroke patients. Conclusions: This survey shows that the minimum level of care is met in Germany and Austria in 63% of hospitals treating stroke patients, whereas the European average is 48.6%. However, the lack of stroke center coverage should encourage health policy decision makers to further improve the infrastructure for acute stroke care in order to make stroke centers available to every stroke victim.

Revised and Updated Recommendations for the Establishment of Primary Stroke Centers

“…Other nations have also adopted and promoted the Stroke Center concept. 6 Preferential triage of patients with acute stroke occurs routinely in some major metropolitan areas and a growing number of cities and states. Protocols for the care of patients with an acute stroke combined with well-formulated disease performance measures are now commonplace in many hospitals, even if they are not a formally designated Stroke Center.…”

“…One or more of these imaging modalities are widely available at most acute care hospitals. 6 Adequately trained echocardiography technicians or cardiac MRI technologists as well as physicians to interpret such images are also recommended.…”

“…5,6 One approach to improving stroke care is the development of Stroke Centers. 7,8 These hospitals would act as focal points for the care of patients with an acute stroke.…”

European Stroke Organisation Recommendations to Establish a Stroke Unit and Stroke Center

“…The limited access of acute stroke patients to adequate stroke unit care in Europe was alarming and still is in many countries. [8][9][10] These studies underline the fact that there is still a great need to improve stroke care also in those countries which have already organized their own evaluation and certification of stroke units. Association.…”

“…8 The frequency of thrombolytic treatment directly depends on the availability and the organizational level of stroke unit care. 10 All ESO Stroke Units must not only be able to deliver thrombolysis in due time but also have timely access to other acute recanalizing interventions (for instance, intra-arterial procedures, although not necessarily on-site). Timely access to interventional thrombectomy in the nearby stroke center would suffice.…”