title: Quality of acute ischemic stroke care in Thailand: a prospective multicenter countrywide cohort study.
abstract: BACKGROUND
  Data concerning quality of acute stroke care and outcome are scarce in developing countries.
  
  
  OBJECTIVE
  This study aimed to evaluate quality of acute stroke care and stroke outcomes in Thailand.
  
  
  METHODS
  We performed a multicenter countrywide prospective cohort study. Consecutive patients with an acute ischemic stroke admitted to the participating institutions between June 2008 and November 2010 were included. Baseline characteristics, process measures including thrombolysis use, acute stroke unit admission, initiation of aspirin within 48 hours, and antithrombotic and/or anticoagulation medication at discharge were recorded. Main outcome measures were death and disability at discharge as well as in-hospital complications.
  
  
  RESULTS
  A total of 1222 patients were included with a mean (±SD) age of 65.0 ± 13 years, and 55.0% were men. Median National Institutes of Health Stroke Scale score was 6.5. Patients were given aspirin within 48 hours, admitted to acute stroke unit, and given thrombolytic therapy in 71.1%, 24.6%, and 3.8%, respectively. Good recovery at discharge (modified Rankin scale score 0-1) was found in 26.1%, and 3.2% of patients died during hospitalization. The median length of stay was 4 days. Factors predicting poor outcome (modified Rankin scale score 5-6) at discharge included: age (by 10-year increments: adjusted odds ratio [OR] 1.23; 95% confidence interval [CI], 1.06-1.43), female sex (adjusted OR 1.52; 95% CI, 1.05-2.19), initial National Institutes of Health Stroke Scale score (adjusted OR 1.35; 95% CI, 1.27-1.43), and in-hospital complications (adjusted OR 3.16; 95% CI, 1.58-6.35).
  
  
  CONCLUSIONS
  Limited access to acute ischemic stroke care interventions were observed in many domains especially thrombolysis and stroke unit admission. These findings emphasize an urgent need for strategies to improve standard acute stroke care among developing countries.
authors.affiliation: Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: yongchai.sae@mahidol.ac.th.
authors.forename: Yongchai
authors.initials: Y
authors.lastname: Nilanont
authors.affiliation: Division of Neurology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
authors.forename: Samart
authors.initials: S
authors.lastname: Nidhinandana
authors.affiliation: Neurological Unit, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Nijasri C
authors.initials: NC
authors.lastname: Suwanwela
authors.affiliation: Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand.
authors.forename: Suchat
authors.initials: S
authors.lastname: Hanchaiphiboolkul
authors.affiliation: Data Management Unit, Clinical Research Collaboration Network (CRCN), 4th Fl. Boromarajonani College of Nursing, Bamrasnaradun Building, Nonthaburi, Thailand.
authors.forename: Taksin
authors.initials: T
authors.lastname: Pimpak
authors.affiliation: Division of Cardiovascular Disease and Internal Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Pyatat
authors.initials: P
authors.lastname: Tatsanavivat
authors.affiliation: Stroke Outcomes Research Center, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.affiliation: Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Niphon
authors.initials: N
authors.lastname: Poungvarin
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003906:Developing Countries; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010351:Patient Discharge; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D013785:Thailand / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D001241:Aspirin
keywords: Stroke registry; Thailand; acute stroke care; quality of stroke care; stroke outcome