Stroke in the young: access to care and outcome; a Western versus eastern European perspective.
BACKGROUND
To develop effective strategies to address the needs of young patients with stroke, it is important to recognize what components of stroke care they receive. The aims of this study were to describe the provision of stroke care and the factors associated with 3-month mortality and disability (Barthel Index 0-14) in patients younger than 55 years across Western and Eastern Europe.


METHODS
Data from hospital-based stroke registers in Western Europe (7 centers, 6 countries) and Eastern Europe (4 centers, 3 countries) were analyzed.


RESULTS
Of 1735 patients admitted to hospital, 201 (11.5%) patients were younger than 55 years (Western European centers 51%, and Eastern European centers 49%). Stroke department care was higher in Western centers (67%) than in Eastern centers (24%) (P < .001). Doctor (P < .001), therapy (P = .01), and nursing (P < .001) time were higher in Western centers. At 3 months, case fatalities between Western and Eastern centers were 8% versus 23% (P = .003). Patients in Eastern European centers were more likely to have disability at 3 months (odds ratio = 24.3, confidence interval = 1.2-494, P = .04).


CONCLUSIONS
Young patients with stroke in Western Europe are more likely to gain access to a number of components of stroke care compared with those in Eastern Europe. The future challenge is to ensure that recommendations are adopted to ensure all young patients receive evidence-based stroke care across Europe.
Bhalla
Ajay
A
Division of Health and Social Care Research, King's College, London, United Kingdom. abhalla@sgul.ac.uk
Grieve
Richard
R
Rudd
Anthony G
AG
Wolfe
Charles D A
CD
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D006291:Health Policy / Q000639:trends; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D017063:Outcome Assessment, Health Care / Q000379:methods; D011787:Quality of Health Care / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D012042:Registries; D020521:Stroke / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult