Acute neurological stroke care in Europe: results of the European Stroke Care Inventory

Abstract

Following the 1997 Recommendations of the EFNS Task Force on Acute Neurological Stroke Care (European Journal of Neurology, 1997: 4:435-441) a European Inventory was undertaken to assess the development of acute stroke care in the EFNS member countries and to give an estimate of the needs based on 1997 data. All 30 members of the EFNS Stroke Scientist Panel were asked to complete a questionnaire on acute stroke epidemiology as well as acute stroke care in their country. Data were based either on national surveys, hospital statistics, or estimates given on the basis of extrapolation of regional studies, or other defined sources. Specialist estimates were also taken into account where no other data source was available. Data from 22 countries were received and referred to almost one million strokes occurring per year in a population of over 500 million. Most epidemiological data confirmed an east-west gap known from previous studies. These included rates that, in eastern countries, were higher for incidence, stroke as a leading cause of death, and 30-day case-fatality, and rates that were lower for overall hospitalization or availability of CT scanning. East-west differences were not seen for the total number of acute stroke units or the number of acute stroke units set up within neurological hospital departments, nor for most other quality indicators of acute stroke care with the exception of technological standards in some countries. The higher rates for 30-day case-fatality in eastern Europe (mostly above 20%) compared with western Europe (mostly below 20%) are probably caused by a case mix with more severe ischemic strokes and a higher percentage of cerebral haemorrhages admitted for acute care in eastern Europe. This is probably due to the higher prevalence of the most common risk factors for stroke in these countries which tend to result in more severe strokes. This, therefore, underlines the need for stroke prevention programmes especially in eastern Europe. This epidemiological east-west gap is not reflected by most quality indicators for acute stroke care, e.g. total number of acute stroke units available within each country. Most eastern European countries have a well-developed neurological care system for acute stroke but still have urgent technological and socioeconomical needs. The leading role of clinical neurology in acute stroke care is visible in most but not all European countries.

Running a Complementary Stroke Rehabilitation and Aftercare Program: Experiences of Four European Centres

“…In Western Europe, the incidence varies between 1.0 and 3.75 per 1000 habitants (Weir et al, 2001). The proportion of patients who die or are dependent at six months after stroke ranges from 20 -41% (Brainin et al, 2000). The consequences after stroke are not only persistent neurological impairment which lead to physical,functional and psychosocial problems, but also life-time disability that requires rehabilitation to enable optimal function.…”

Recommendations for Stroke Management

“…In developed countries, stroke is the second cause of death 1 , and in Croatia it is the leading cause of death for women 2 . Due to modifications of lifestyle and risk factors, and better stroke management, the incidence of stroke in developed countries has decreased and its mortality has been reduced 3,4 . Nevertheless, the treatment of stroke is far from being satisfactory.…”

“…Nevertheless, the treatment of stroke is far from being satisfactory. Over the past decade, acute stroke has finally been recognized as a medical emergency 4,5 . World Federation of Neurology Research Group on Organization and Delivery of Neurological Services has published recommendations for prevention of cerebrovascular diseases.…”

Stroke Unit care in Italy. Results from PROSIT (Project on Stroke Services in Italy). A nationwide study

“…The utility of these structural and performance characteristics needs validation from outcome studies. [3]. Many stroke physicians claim that these delays in SU implementation are due to a shortage of adequate resources.…”