Facilities available in European hospitals treating stroke patients.
OBJECTIVE
Stroke units decrease mortality and need for institutional care, but they are not widely available. The objective of the study was to determine, among European hospitals admitting acute stroke patients, how many are able to provide an appropriate level of care. Method- We randomly selected 886 hospitals in 25 countries. We used definitions derived from a European expert survey for comprehensive stroke centers (CSC), primary stroke centers (PSC), and minimum level required for any hospital ward (AHW) admitting stroke patients. We determined the proportion of hospitals meeting criteria for each category, and which facilities were not available.


RESULTS
Participating hospitals treated approximately one-third of all strokes supposed to have occurred in these countries in 2005. Forty-three (4.9%) met criteria for CSC, 32 (3.6%) for PSC, 356 (40.2%) for AHW, and 455 (51.4%) provided a lower level of care. In 2005, hospitals meeting criteria for CSC, PSC, AHW, and none of them admitted 27 644 (8.3%), 17 365 (5.2%), 146 175 (44.1%), and 140 306 (42.3%) patients. There was no 24-hour availability for brain CT scan in 25% of hospitals not meeting criteria for AHW. Of 448 hospitals admitting at least 1 stroke per day, 51 (11.4%) met criteria for PSC or CSC, and 227 (50.7%) for AHW.


CONCLUSIONS
Less than 10% of European hospitals admitting acute stroke patients have optimal facilities, and in 40% even the minimum level is not available. Because the availability of facilities does not grant their use, our study suggests that only few acute stroke patients are treated in appropriate centers in Europe.
Leys
Didier
D
Department of Neurology, University Hospital of Lille, 59037 Lille, France. dleys@chru-lille.fr
Ringelstein
E Bernd
EB
Kaste
Markku
M
Hacke
Werner
W
D000208:Acute Disease; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005060:Europe; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data / Q000639:trends; D006757:Hospital Units / Q000592:standards* / Q000706:statistics & numerical data / Q000600:supply & distribution*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data / Q000600:supply & distribution; D007902:Length of Stay; D017063:Outcome Assessment, Health Care / Q000379:methods; D011785:Quality Assurance, Health Care; D020521:Stroke / Q000451:nursing* / Q000628:therapy*; D011795:Surveys and Questionnaires; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D010959:Tissue Plasminogen Activator