The quality of acute stroke units on a nation‐wide level: the Austrian Stroke Registry for acute stroke units

Abstract

Concepts for stroke units that cover the acute phase vary. Therefore, the network of acute stroke units that is being set up in Austria in a uniform way is of general interest. This nationwide network has been established in accordance to evidence-based recommendations and prespecified criteria for available resources. The location for such a unit follows a maximum of 90-min isochrones (transport time) to the hospital. The quality of the network is currently documented and the results are reported. A nationwide stroke registry was prospectively performed on 15 stroke units that were already functional in this network. The aim was to document the quality performance of Austrian stroke units, focusing on rapid admissions, ready availability of investigations and therapies performed. Outcome measures were Barthel scale, Rankin score and percentages of complications. Between August 1998 and December 2000, 2,313 patients with ischemic stroke or with primary intracerebral hemorrhage admitted to an Austrian stroke unit within 24 h after onset of symptoms were prospectively included. Forty-three percent of the patients had a moderate or severe stroke. Fifty-seven percent of all patients were admitted to the stroke unit within 3 h after the onset of symptoms. Twenty-seven percent of these patients were brought in by ambulance accompanied by an emergency physician. Two percent of patients were admitted by helicopter. Fifty-four percent of patients had their first brain imaging within 30 min after admission, another 26% within 3 h. Intravenous thrombolysis was performed in 4.1% of patients. The overall stroke-unit mortality was about 6.8% and mortality at 3 months was 12.9%. The outcome at 3 months showed a modified Rankin Scale score of 0 or 1 in 47% of patients, denoting none or mild impairment. This network of acute stroke units is highly efficient in terms of rapid admissions, short intrahospital delays, as well as rapid use of readily available investigations. Stroke units seem to be well accepted by the general public and the medical community because our data show that all types of strokes are treated in Austrian stroke units, including severe strokes. The total number of concurrently treated acute strokes in other institutions across Austria is not known and no formal comparison with other systems of hospitalized care was undertaken, therefore further research is necessary.

Trends in Mortality From Ischemic Heart Disease and Cerebrovascular Disease in Europe

“…17,18 Another factor could be the unregulated access to all levels of health care and 19 The Austrian acute stroke service is also efficient with fast admissions, good availability of investigation modalities, and few delays. 20 Conversely, Bulgaria has the highest CVD mortality for both sexes, but relatively low IHD mortality, possibly related to the prevalence of heavy alcohol use in the country. 21 Lithuania has the present-day highest rate of IHD mortality for both sexes, although there is a decreasing trend for mortality in this study.…”

European Stroke Facilities Survey: The German and Austrian Perspective

“…This advantage is clearly the consequence of a strong effort of the German Stroke Foundation, Gütersloh, and the German Stroke Society [25] of establishing more than 180 certified stroke units all over Germany, and by the Austrian Stroke Society of installing 31 stroke units in Austria within the last 12 years. The performance of the first 15 units between 1998 and 2000 has been published in detail [30]. Strong efforts are presently undertaken by several German states to achieve full coverage for their territory with comprehensive or primary stroke centers within the next years by supporting major hospitals to build up stroke units, preferably in neurological departments.…”

Stroke Monitoring on a National Level

“…National databases for stroke have been instituted in Sweden, [2][3][4] Scotland, 5 the rest of the United Kingdom, 6 -9 Germany, 10 -12 Poland, 13,14 Austria, 15 Argentina, 16 Japan, 17,18 South Korea, 19 Canada, 20 -22 and the United States. 23 All of the databases are hospital based, most rely on voluntary reporting by hospitals, and nationwide coverage of stroke patients varies.…”