Abstract WP376: Effects of Organized Stroke Care Capacities on In-hospital Mortality of Patients with Ischemic and Hemorrhagic Stroke. J-ASPECT Study
Background and Purpose Data on the effectiveness of organized stroke care on mortality of patients with ischemic and hemorrhagic stroke are limited. In this study, we examined whether organized stroke care for all types of stroke influence the stroke in-hospital mortality in the real-world setting.
Methods Of the 1381 certified training institutions of the Japan Neurosurgical Society and/or the Japan Stroke Society, 751 hospitals responded to a survey with questions regarding organized stroke care capacities. Organized stroke care capacities were assessed by 25 items divided into 7 subcategory score regarding personnel with specific expertise, diagnostic techniques, surgical and interventional therapies, infrastructure and educational components recommended for comprehensive stroke center (Albers et al. Stroke 2005). Among the institutions that responded, data on patients hospitalized due to stroke were obtained from the Japanese Diagnosis Procedure Combination database in 2011. In-hospital mortality was analyzed with the total and subcategory scores using hierarchical logistic regression analysis adjusted for age, sex and institutional difference.
Results Data of 256 institutions and 53,170 emergency hospitalized patients were analyzed. Mortality rates were 7.8% for cerebral infarction(CI), 16.8% for intracerebral hemorrhage(ICH), and 28.1% for subarachnoid hemorrhage(SAH). Mortality of CI was significantly correlated with total score (OR=0.97, 95%CI=0.96-0.99), subcategory score in personnel (OR=0.93,95%CI=0.88-0.99), infrastructure (OR=0.92, 95%CI=0.87-0.97) and education (OR=0.88, 95%CI=0.81-0.95) adjusted for age and sex. Mortality of ICH was significantly correlated with total score (OR = 0.98, 95% CI: 0.96-1.00), diagnostic technique (OR = 0.93; 95% CI: 0.87-0.99) and education (OR = 0.90; 95% CI: = 0.83-0.98). Mortality of SAH was significantly associated with total score (OR = 0.96; 95% CI: 0.93-0.98), surgical and interventional therapies (OR = 0.84; 95% CI: 0.77-0.92), infrastructure (OR = 0.91, 95% CI: 0.84-0.98) and education (OR = 0.83, 95% CI: 0.75-0.92).
Conclusion Organized stroke care was associated with in-hospital mortality rates depending on the stroke types.
- © 2012 by American Heart Association, Inc.