Effectiveness of primary and comprehensive stroke centers: PERFECT stroke: a nationwide observational study from Finland.
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.
Meretoja
Atte
A
Department of Neurology, Helsinki University Central Hospital, PO Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi
Roine
Risto O
RO
Kaste
Markku
M
Linna
Miika
M
Roine
Susanna
S
Juntunen
Merja
M
Erilä
Terttu
T
Hillbom
Matti
M
Marttila
Reijo
R
Rissanen
Aimo
A
Sivenius
Juhani
J
Häkkinen
Unto
U
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*