Quality of Acute Ischemic Stroke Care in Thailand: A Prospective Multicenter Countrywide Cohort Study

Nilanont, Yongchai; Nidhinandana, Samart; Suwanwela, Nijasri C.; Hanchaiphiboolkul, Suchat; Pimpak, Taksin; Tatsanavivat, Pyatat; Saposnik, Gustavo; Poungvarin, Niphon

doi:10.1016/j.jstrokecerebrovasdis.2012.12.001

Cited by 39 publications

(54 citation statements)

References 36 publications

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“…A recent systematic review 17 assessed the global use of rtPA for AIS among 214 countries and found that only 54 (25%) of these countries reported its administration, ranging from as low as 3% (1 of 36) of low-income, to 13% (7 of 54) of lower middle-income, to 28% (15 of 54) of upper middle-income, and to 44% (31 of 70) of highincome countries. 17 In comparison, access to rtPA in Iran is lower than in most of the developed countries [18][19][20][21][22][23][24][25] but comparable with other developing countries [26][27][28][29][30][31][32] ( Fig 2). The barriers of timely administration of rtPA in developing countries include limited resources, prehospital delay, sparse numbers of stroke units, 16,33 poor stroke awareness in the general population, 33 lack of general knowledge and professional education, 33,34 the high cost of rtPA, lack of insurance coverage, low socioeconomic status of patients, 16,33 and physician reluctance and concerns about the benefits compared with its serious side effects, especially bleeding.…”

Section: Discussionmentioning

confidence: 86%

Gaps and Hurdles Deter against Following Stroke Guidelines for Thrombolytic Therapy in Iran: Exploring the Problem

Nikkhah

Avan

Shoeibi

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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Section: Discussionmentioning

confidence: 86%

Gaps and Hurdles Deter against Following Stroke Guidelines for Thrombolytic Therapy in Iran: Exploring the Problem

Nikkhah

Avan

Shoeibi

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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“…Nonetheless, our data show that the overall burden of stroke in younger adults is increasing globally, with significant increases in absolute numbers of young people living with stroke and a disproportionate burden in developing countries. This has implications for healthcare and management resources, as well as plans for preventative measures to reduce this burden [17,18]. …”

Section: Discussionmentioning

confidence: 99%

Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013: Data from the Global Burden of Disease 2013 Study

et al. 2015

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Background: Recent evidence suggests that stroke is increasing as a cause of morbidity and mortality in younger adults, where it carries particular significance for working individuals. Accurate and up-to-date estimates of stroke burden are important for planning stroke prevention and management in younger adults. Objectives: This study aims to estimate prevalence, mortality and disability-adjusted life years (DALYs) and their trends for total, ischemic stroke (IS) and hemorrhagic stroke (HS) in the world for 1990-2013 in adults aged 20-64 years. Methodology: Stroke prevalence, mortality and DALYs were estimated using the Global Burden of Disease (GBD) 2013 methods. All available data on rates of stroke incidence, excess mortality, prevalence and death were collected. Statistical models were used along with country-level covariates to estimate country-specific stroke burden. Stroke-specific disability weights were used to compute years lived with disability and DALYs. Means and 95% uncertainty intervals (UIs) were calculated for prevalence, mortality and DALYs. The median of the percent change and 95% UI were determined for the period from 1990 to 2013. Results: In 2013, in younger adults aged 20-64 years, the global prevalence of HS was 3,725,085 cases (95% UI 3,548,098-3,871,018) and IS was 7,258,216 cases (95% UI 6,996,272-7,569,403). Globally, between 1990 and 2013, there were significant increases in absolute numbers and prevalence rates of both HS and IS for younger adults. There were 1,483,707 (95% UI 1,340,579-1,658,929) stroke deaths globally among younger adults but the number of deaths from HS (1,047,735 (95% UI 945,087-1,184,192)) was significantly higher than the number of deaths from IS (435,972 (95% UI 354,018-504,656)). There was a 20.1% (95% UI -23.6 to -10.3) decline in the number of total stroke deaths among younger adults in developed countries but a 36.7% (95% UI 26.3-48.5) increase in developing countries. Death rates for all strokes among younger adults declined significantly in developing countries from 47 (95% UI 42.6-51.7) in 1990 to 39 (95% UI 35.0-43.8) in 2013. Death rates for all strokes among younger adults also declined significantly in developed countries from 33.3 (95% UI 29.8-37.0) in 1990 to 23.5 (95% UI 21.1-26.9) in 2013. A significant decrease in HS death rates for younger adults was seen only in developed countries between 1990 and 2013 (19.8 (95% UI 16.9-22.6) and 13.7 (95% UI 12.1-15.9)) per 100,000). No significant change was detected in IS death rates among younger adults. The total DALYs from all strokes in those aged 20-64 years was 51,429,440 (95% UI 46,561,382-57,320,085). Globally, there was a 24.4% (95% UI 16.6-33.8) increase in total DALY numbers for this age group, with a 20% (95% UI 11.7-31.1) and 37.3% (95% UI 23.4-52.2) increase in HS and IS numbers, respectively. Conclusions: Between 1990 and 2013, there were significant increases in prevalent cases, total deaths and DALYs due to HS and IS in younger adults aged 20-64 years. Death and DALY rates declined in ...

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“…After excluding that study, antiplatelets for ischemic stroke remained with a single study (43) which showed no association with poor outcome (OR: 1.25, 95% CI: 0.73-2.14).…”

Section: [Insert Figure 3 Here]mentioning

confidence: 99%

“…One study (18) reported eleven KPIs including hypoxia management, early medical assessment, antidepressant therapy, activities of daily living (ADLs) rehabilitation, home assessment, balance rehabilitation, secondary prevention on discharge, education to patients, discussing post-discharge needs with patients, intermittent catheterization, and constipation risk assessment. 21 Stroke unit admission was variably defined across the related studies (15,17,18,21,22,(24)(25)(26)(27)43). Two Danish studies (17,18) defined a "stroke unit" as a hospital department/unit that exclusively or primarily is dedicated to patients with stroke and which is characterized by multidisciplinary teams, a staff with a specific interest in stroke, involvement of relatives, and continuous education of the staff.…”

Section: Key Performance Indicatorsmentioning

confidence: 99%

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Association between patient outcomes and key performance indicators of stroke care quality: A systematic review and meta-analysis

Urimubenshi

Langhorne

Cadilhac

et al. 2017

European Stroke Journal

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Quality of Acute Ischemic Stroke Care in Thailand: A Prospective Multicenter Countrywide Cohort Study

Cited by 39 publications

References 36 publications

Gaps and Hurdles Deter against Following Stroke Guidelines for Thrombolytic Therapy in Iran: Exploring the Problem

Gaps and Hurdles Deter against Following Stroke Guidelines for Thrombolytic Therapy in Iran: Exploring the Problem

Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013: Data from the Global Burden of Disease 2013 Study

Association between patient outcomes and key performance indicators of stroke care quality: A systematic review and meta-analysis

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