title: Effectiveness of primary and comprehensive stroke centers: PERFECT stroke: a nationwide observational study from Finland.
abstract: OBJECTIVE
  Previous studies show better outcomes for patients with stroke receiving care in stroke units, but many different stroke unit criteria have been published. In this study, we explored whether stroke centers fulfilling standardized Brain Attack Coalition criteria produce better patient outcomes than hospitals without stroke centers.
  
  
  METHODS
  We did an observational register-linkage study of all patients with ischemic stroke treated in Finland between 1999 and 2006. After exclusion of recurrent strokes and nonanalyzable patients, we included 61 685 consecutive patients treated in 333 hospitals classified in national audits either as Comprehensive Stroke Centers, Primary Stroke Centers, or General Hospitals according to Brain Attack Coalition criteria. Primary outcome measures were case-fatality and being in institutional care 1 year after stroke.
  
  
  RESULTS
  Care in stroke centers was associated with lower 1-year case-fatality and reduced institutional care compared with General Hospitals. The number-needed-to-treat to prevent 1 death or institutional care at 1 year was 29 for Comprehensive Stroke Centers and 40 for Primary Stroke Centers versus General Hospitals. Patients treated in stroke centers had lower mortality during the entire follow-up of up to 9 years and their median survival was increased by 1 year.
  
  
  CONCLUSIONS
  This study shows a clear association between the level of acute stroke care and patient outcome and supports use of published criteria for primary and comprehensive stroke centers.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, PO Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi
authors.forename: Atte
authors.initials: A
authors.lastname: Meretoja
authors.forename: Risto O
authors.initials: RO
authors.lastname: Roine
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Miika
authors.initials: M
authors.lastname: Linna
authors.forename: Susanna
authors.initials: S
authors.lastname: Roine
authors.forename: Merja
authors.initials: M
authors.lastname: Juntunen
authors.forename: Terttu
authors.initials: T
authors.lastname: Erilä
authors.forename: Matti
authors.initials: M
authors.lastname: Hillbom
authors.forename: Reijo
authors.initials: R
authors.lastname: Marttila
authors.forename: Aimo
authors.initials: A
authors.lastname: Rissanen
authors.forename: Juhani
authors.initials: J
authors.lastname: Sivenius
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
mesh_terms: D000046:Academic Medical Centers; D018572:Disease-Free Survival; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality / Q000628:therapy*