title: Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study.
abstract: BACKGROUND
  Although the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances.
  
  
  METHODS
  Of the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education. Consistency and validity were examined using correlation coefficients and factorial analysis.
  
  
  RESULTS
  The CSC score (median, 14; interquartile range, 11-18) varied according to hospital volume. The five subcategories showed moderate consistency (Cronbach's α = 0.765). A strong correlation existed between types of available personnel and specific expertise. Using the 2011 Japanese Diagnosis Procedure Combination database for patients hospitalized with stroke, four constructs were identified by factorial analysis (neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and neurocritical care and rehabilitation) that affected in-hospital mortality from ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The total CSC score was related to in-hospital mortality from ischemic stroke (odds ratio [OR], 0.973; 95% confidence interval [CI], 0.958-0.989), intracerebral hemorrhage (OR, 0.970; 95% CI, 0.950-0.990), and subarachnoid hemorrhage (OR, 0.951; 95% CI, 0.925-0.977), with varying contributions from the four constructs.
  
  
  CONCLUSIONS
  The CSC score is a valid measure for assessing CSC capabilities, based on the availability of neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and critical care and rehabilitation services.
authors.affiliation: Department of Clinical Trials and Research, Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan. akiko.kada@nnh.go.jp.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kada
authors.affiliation: Center for Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.affiliation: Chiba Cardiovascular Center, Ichihara, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ono
authors.affiliation: Department of Neurosurgery, Kyorin University, Mitaka, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.affiliation: Showa University, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Aruga
authors.affiliation: Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyachi
authors.affiliation: Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
authors.affiliation: Departments of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.affiliation: Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kita-Kyushu, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.affiliation: Akita Prefectural Hospital Organization Research Institute for Brain and Blood Vessels, Akita, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Suzuki
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Kataoka
authors.affiliation: Center for Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Nakamura
authors.affiliation: Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kamitani
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000628:therapy*; D002561:Cerebrovascular Disorders / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
keywords: Cerebrovascular circulation; Hemorrhage; Ischemia; Risk factors; Stroke