Quality Monitoring of Acute Stroke Care in Rhineland-Palatinate, Germany, 2001–2006

Grau, Armin J.; Eicke, Martin; Biegler, M.; Faldum, Andreas; Bamberg, Christian; Haaß, A.; Hardt, Roland; Hufschmidt, Andreas; Lowitzsch, К.; Marx, Jürgen; Schmitt, Eberhard; Schoenemann, Hartmut; Arnim, Wolf von; Weiß, H.; Dienlin, Sieghard

doi:10.1161/strokeaha.110.582239

Cited by 34 publications

(25 citation statements)

References 15 publications

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“…Similar findings have previously been seen in other stroke registries and databases [15,24,25], but not in all [26]. This has been attributed to an increase in stroke incidence in Western societies (presumably as a result of higher life expectancy) [15,25,27,28,29]. Indeed, between 2007 and 2011 numbers of inhabitants 65 years of age or older increased by 0.5% to 19.49% of the population [23].…”

Section: Discussionsupporting

confidence: 91%

“…Within the study population, absolute and relative numbers of stroke patients 80 years of age or older in our database increased most over time. Similar findings have previously been seen in other stroke registries and databases [15,24,25], but not in all [26]. This has been attributed to an increase in stroke incidence in Western societies (presumably as a result of higher life expectancy) [15,25,27,28,29].…”

Section: Discussionsupporting

confidence: 85%

“…In comparison to other stroke registers and databases, all hospitalized patients are included consecutively, thus also comprising patients not treated in a stroke unit. This distinguishes the database in BW from some others [15] and makes it possible to comparatively analyze patients treated in general wards or in specialized stroke units. Furthermore, the three-level stroke unit concept can also be evaluated.…”

Section: Discussionmentioning

confidence: 99%

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A Consecutive and Prospective Stroke Database Covers the State of Baden-Wuerttemberg with 10.8 Million Inhabitants in Germany

Gumbinger

Reuter²,

Wiethölter³

et al. 2013

Neuroepidemiology

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Background: In 1998 Baden-Wuerttemberg (BW), a federal state in southwest Germany with 10.8 million inhabitants, implemented a structured medical concept for the treatment of acute stroke. Methods: Since 2004 participation in the BW stroke database is mandatory for all hospitals in BW involved in acute stroke care. The stroke database includes all inpatients ≥18 years of age who have suffered an ischemic or hemorrhagic stroke within 7 days before hospitalization. This article presents methodological aspects and first results of the BW stroke database in the time period from 2007 to 2011. Results: Annual inclusion numbers increased continuously (29,422 vs. 35,724, p < 0.001). Median age of stroke onset was stable over time. The proportion of stroke patients ≥80 years increased from 36.9 to 38.8% (p < 0.001). Rates of patients treated in neurology departments rose from 50.7 to 60.9% (p < 0.001) and numbers of patients treated in stroke units rose from 59.1 to 68.4% (p < 0.001). Admission via emergency medical systems increased from 42.8 to 49.7% (p < 0.001) and arrival within 3 h increased from 29.8 to 34.4% (p < 0.001). Conclusion: We present results from a large, prospective and consecutive stroke patient database. This first analysis demonstrates a continuous increase of absolute and relative numbers of stroke patients who arrive within 3 h after onset, are hospitalized in neurology departments and treated in stroke units, and are aged ≥80 years.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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A Consecutive and Prospective Stroke Database Covers the State of Baden-Wuerttemberg with 10.8 Million Inhabitants in Germany

Gumbinger

Reuter²,

Wiethölter³

et al. 2013

Neuroepidemiology

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“…Starting in 2010, this also included patients who suffered from stroke/TIA while being treated in hospital for other diseases. Details of the quality monitoring project have been reported previously [10]. Shortly, physicians in all participating hospitals are required to complete a structured questionnaire for each patient.…”

Section: Methodsmentioning

confidence: 99%

“…Rankin Scale and Barthel index are also assessed for the period before stroke/TIA. The etiology of ischemic stroke/TIA is analyzed according to a modification of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria; in addition to the 5 subgroups of the TOAST classification, a subgroup called “presumed local atherothrombotic etiology” is added when large brain supplying arteries show atherosclerotic lesions with <50% diameter reduction in case of lack of other stroke etiologies [10]. Questionnaires are sent electronically to the state quality monitoring institution (SQMed Mainz) .…”

Section: Methodsmentioning

confidence: 99%

Risk of Ischemic Stroke and Transient Ischemic Attack Is Increased up to 90 Days after Non-Carotid and Non-Cardiac Surgery

Grau

Eicke²,

Burmeister³

et al. 2017

Cerebrovasc Dis

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Background: The risk of stroke after cardiac and carotid surgery is well established. In contrast, stroke risk in association with non-cardiac and non-carotid surgery and its time course are insufficiently known. We investigated the prevalence of recent and planned surgery among patients with stroke and transient ischemic attack (TIA), time dependency of stroke risk, stroke etiology, and interruption of antithrombotic medication in association with surgery. Methods: Data on type and date of surgery and similar interventions within the last year or planned for the next 2 weeks were anonymously collected together with demographic data, vascular risk factors, stroke severity, handicap before stroke and stroke etiology within a state-wide, mandatory, hospital-based acute stroke care quality monitoring project (Rhineland-Palatinate, Germany) for 1 year (2010). Results: Non-carotid and non-cardiothoracic surgery was reported as performed within 1 year before the index event or as planned for the next 2 weeks thereafter in 532 out of 12,120 patients with ischemic stroke/TIA (4.4%). Compared to 91-365 days before stroke/TIA as reference period, risk of cerebral ischemia (per day analysis) was increased for surgery within 61-90 days before ischemia (rate ratio 2.0, 95% CI 1.5-2.8) and continuously increased along shorter intervals between stroke and surgery (31-60 days: rate ratio 3.6, 95% CI 2.9-4.5; 15-30 days: rate ratio 8.2, 95% CI 6.7-10.1; 8-14 days: rate ratio 13.2, 95% CI 10.3-16.8; 4-7 days: rate ratio 16.5, 95% CI 12.2-22.1) peaking at an interval of 1-3 days before ischemia (rate ratio 34.0, 95% CI 26.9-42.8). On the day of surgery, rate ratio was 14.8 (95% CI 7.8-27.9) and for planned surgery it was 2.7 (95% CI 1.8-4.0). Results were similar for first-ever and for recurrent ischemic stroke. Perioperative stroke/TIA was positively associated with atrial fibrillation and cardioembolic stroke etiology, higher mortality, more severe neurological deficits at discharge, and longer hospital stay; and it was inversely associated with microangiopathic etiology and discharge at home. In 34.5% of patients with recent/planned surgery, prior antithrombotic or anticoagulant medication had been interrupted. Conclusions: Recent or planned surgery imposes a considerable short-term stroke risk particularly by cardioembolism with cessation of medication as an important contributor. Stroke after surgery is associated with poor outcome and high mortality. Better strategies to reduce the burden of perioperative stroke are urgently required.

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Diagnostic accuracy of STAF, LADS, and iPAB scores for predicting paroxysmal atrial fibrillation in patients with acute cerebral infarction

Chen

Luo

et al. 2018

Clinical Cardiology

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Background and objective The scoring scales scoring system for targeting atrial fibrillation (STAF), left atrial diameter, age, diagnosis of stroke, and smoking status (LADS), and identified by past history of arrhythmia or antiarrhythmic agent use, atrial dilation, and elevation of Brain natriuretic peptide (iPAB) have been proposed for predicting atrial fibrillation in patients with acute cerebral infarction, but their relative accuracies are not clear. This prospective study compared STAF, LADS, and iPAB scores for predicting paroxysmal atrial fibrillation (PAF) in patients with acute cerebral infarction. Methods Patients with acute cerebral infarction (n = 744; 495 men, 249 women; aged 65 ± 12 years) were consecutively enrolled throughout the year 2016 at the Department of Neurology of Huizhou Municipal Central Hospital. Patients were followed for 3 months. The sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and best cutoff points of STAF, LADS, and iPAB scores for predicting PAF were computed. Results Among the 744 patients, 37 patients had PAF. The AUCs of the STAF, LADS, and iPAB scores for predicting PAF were 0.87, 0.79, and 0.84, respectively, and with a cutoff at four points, the sensitivities were 73%, 70.3%, and 83.8%, and specificities were 92.1%, 82.2%, and 77%. Conclusions The STAF, LADS, and iPAB scores could satisfactorily predict PAF in patients with acute cerebral infarction. STAF was superior to the others in diagnostic performance.

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Quality Monitoring of Acute Stroke Care in Rhineland-Palatinate, Germany, 2001–2006

Cited by 34 publications

References 15 publications

A Consecutive and Prospective Stroke Database Covers the State of Baden-Wuerttemberg with 10.8 Million Inhabitants in Germany

A Consecutive and Prospective Stroke Database Covers the State of Baden-Wuerttemberg with 10.8 Million Inhabitants in Germany

Risk of Ischemic Stroke and Transient Ischemic Attack Is Increased up to 90 Days after Non-Carotid and Non-Cardiac Surgery

Diagnostic accuracy of STAF, LADS, and iPAB scores for predicting paroxysmal atrial fibrillation in patients with acute cerebral infarction

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