Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study.
BACKGROUND
The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke.


RESULTS
Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH.


CONCLUSIONS
CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Koji
K
Iihara
Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan.
Kunihiro
K
Nishimura
Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.
Akiko
A
Kada
Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center, Suita, Japan.
Jyoji
J
Nakagawara
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
Kuniaki
K
Ogasawara
Chiba Cardiovascular Center, Ichihara, Japan.
Junichi
J
Ono
Department of Neurosurgery, Kyorin University, Mitaka, Japan.
Yoshiaki
Y
Shiokawa
Showa University Hospital, Tokyo, Japan.
Toru
T
Aruga
Department of Neurosurgery, Nagoya University, Nagoya, Japan.
Shigeru
S
Miyachi
Department of Neurosurgery, Nagasaki University, Nagasaki, Japan.
Izumi
I
Nagata
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Kazunori
K
Toyoda
Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kita-Kyushu, Japan.
Shinya
S
Matsuda
Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan.
Yoshihiro
Y
Miyamoto
Research Institute for Brain and Blood Vessels, Akita, Japan.
Akifumi
A
Suzuki
Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
Koichi B
KB
Ishikawa
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
Hiroharu
H
Kataoka
Department of Public Health, The University of Tokyo, Tokyo, Japan.
Fumiaki
F
Nakamura
Department of Public Health, The University of Tokyo, Tokyo, Japan.
Satoru
S
Kamitani
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003191:Comprehensive Health Care / Q000458:organization & administration*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000473:pathology / Q000628:therapy