JOURNAL OF THE NEUROLOGICAL SCIENCES | 卷:371 |
Regional variation in acute stroke care organisation | |
Article | |
Munoz Venturelli, Paula1,2  Robinson, Thompson4  Lavados, Pablo M.2,3,5  Olavarria, Veronica V.2  Arima, Hisatomi6  Billot, Laurent1  Hackett, Maree L.1,7  Lim, Joyce Y.1  Middleton, Sandy8,9  Pontes-Neto, Octavio10  Peng, Bin11  Cui, Liying11  Song, Lily12  Mead, Gillian13  Watkins, Caroline7,8,9  Lin, Ruey-Tay14  Lee, Tsong-Hai15,16  Pandian, Jeyaraj17  de Silva, H. Asita18  Anderson, Craig S.1,19,20  | |
[1] Univ Sydney, George Inst Global Hlth, Sydney, NSW, Australia | |
[2] Univ Desarrollo, Clin Alemana, Fac Med,Dept Med, Unidad Neurol Vasc,Serv Neurol,Dept Med, Santiago, Chile | |
[3] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England | |
[4] Univ Leicester, NIHR Biomed Res Unit Cardiovasc Dis, Leicester, Leics, England | |
[5] Univ Chile, Fac Med, Dept Ciencias Neurol, Santiago, Chile | |
[6] Fukuoka Univ, Fac Med, Dept Prevent Med & Publ Hlth, Fukuoka, Japan | |
[7] Univ Cent Lancashire, Coll Hlth & Wellbeing, Preston, Lancs, England | |
[8] St Vincents Hlth Australia Sydney, Nursing Res Inst, Sydney, NSW, Australia | |
[9] Australian Catholic Univ, Sydney, NSW, Australia | |
[10] Univ Sao Paulo, Ribeirao Preto Sch Med, Div Neurol, Stroke Serv, Ribeirao Preto, Brazil | |
[11] Beijing Union Med Coll Hosp, Dept Neurol, Beijing, Peoples R China | |
[12] Shanghai 85th Hosp PLA, Dept Neurol, Shanghai, Peoples R China | |
[13] Univ Edinburgh, Ctr Clin Brain Sci, Dept Geriatr Med, Edinburgh EH8 9YL, Midlothian, Scotland | |
[14] Kaohsiung Med Univ, Chung Ho Mem Hosp, Dept Neurol, Kaohsiung, Taiwan | |
[15] Chang Gung Univ, Linkou Chang Gung Mem Hosp, Dept Neurol, Taoyuan, Taiwan | |
[16] Chang Gung Univ, Coll Med, Taoyuan, Taiwan | |
[17] Christian Med Coll & Hosp, Dept Neurol, Ludhiana, Punjab, India | |
[18] Univ Kelaniya, Fac Med, Dept Pharmacol, Clin Trials Unit, Ragama, Sri Lanka | |
[19] Royal Prince Alfred Hosp, Dept Neurol, Sydney, NSW, Australia | |
[20] Peking Univ, Hlth Sci Ctr, George Inst, Beijing, Peoples R China | |
关键词: Stroke; Stroke care; Acute ischemic stroke; Intracerebral hemorrhage; Thrombolysis; In- and out-hospital stroke care organisation; | |
DOI : 10.1016/j.jns.2016.10.026 | |
来源: Elsevier | |
【 摘 要 】
Background: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). Methods: HeadPoST is an on-going international multicenter crossover cluster -randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. Results: 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P < 0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P = 0.002) compared to MIC hospitals. Conclusions: Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes. (C) 2016 Elsevier B.V. All rights reserved.
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