Acute stroke management in the local general hospital.
OBJECTIVE
The majority of stroke patients are treated in local general hospitals. Despite this fact, little is known about stroke care in these institutions. We sought to investigate the status quo of acute stroke management in nonspecialized facilities with limited equipment and resources.


METHODS
Four general hospitals located in smaller cities of a rural area in Germany participated in this study. The 4 hospitals were similar in structure and technical equipment; none had a CT scanner in-house. We reviewed the medical records of every stroke patient hospitalized in 1 of the 4 hospitals within a period of 8 weeks within 1 year.


RESULTS
We collected data of a total of 95 patients at all 4 hospitals. The frequency of diagnostic tests was low: at least 1 CT scan was obtained in only 36.8% of all cases, whereas diagnostic methods available in-house were used more frequently, such as Doppler ultrasound (49.0%), echocardiography (42.3%), and 24-hour ECG registration (48.4%). Each hospital had a different therapeutic approach. Main therapeutic options were the use of pentoxyfilline (0% to 90.5%), osmodiuretics (0% to 90%), piracetam (0% to 93.3%), and hydroxyethylstarch (4.8% to 30%). Medication for long-term secondary prevention was given to 69.8% of all patients.


CONCLUSIONS
This study provides one of the few data samples reflecting stroke care in smaller general hospitals. The findings demonstrate a partially suboptimal level of care in these institutions. To achieve future improvements, extended human and technical resources as well as research for stroke care should not be restricted to academic stroke centers.
Handschu
R
R
Department of Neurology, Friedrich-Alexander Universitaet Erlangen-Nürnberg, Erlangen, Germany. rene.handschu@neuro.med.uni-erlangen.de
Garling
A
A
Heuschmann
P U
PU
Kolominsky-Rabas
P L
PL
Erbguth
F
F
Neundörfer
B
B
D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000706:statistics & numerical data; D005858:Germany; D006295:Health Resources / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000592:standards* / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D010431:Pentoxifylline / Q000627:therapeutic use; D010889:Piracetam / Q000627:therapeutic use; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data
D004232:Diuretics; D006895:Hydroxyethyl Starch Derivatives; D010431:Pentoxifylline; D010889:Piracetam