Konzept der überregionalen und regionalen Schlaganfallversorgung in Deutschland

Ringelstein, E. Bernd; Berlit, P.; Busse, O.; Hc, Diener; Grotemeyer, K.-H.; Haberl, R.; Hacke, Werner; Harms, L.; Kaps, M.; Kessler, Christof

doi:10.1055/s-2007-1017527

Cited by 20 publications

(8 citation statements)

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“…The present study aimed in particular at analyzing the situation of acute stroke care in Germany and Austria. Both countries are known to have invested major efforts in the establishment of certified stroke units in a considerable proportion of hospitals treating stroke patients, and on most occasions, neurologists are responsible for the care of stroke patients which has been shown to improve the outcome of them [2, 4, 14, 16,23,24,25]. The criterion for the selection of the hospitals analyzed was their definitive involvement in every day acute stroke care.…”

Section: Discussionmentioning

confidence: 99%

“…In this nested analysis, we analyzed the German and Austrian hospitals together, because the level of stroke care is similar in Germany and Austria based on shared descriptions and recommendations [4, 14, 16, 23]. It should be noted that this study was not designed to investigate outcomes of stroke patients, but only types of facilities available to them.…”

Section: Methodsmentioning

confidence: 99%

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European Stroke Facilities Survey: The German and Austrian Perspective

et al. 2008

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Background: The aim of this nested analysis was to identify the major components of stroke centers and other facilities actually available for acute stroke patients in hospitals of Germany and Austria. Methods: This analysis is part of a much larger European Stroke Facility Survey of 886 hospitals treating stroke patients all over Europe initiated by the European Stroke Initiative. Three levels of stroke care were predefined: comprehensive stroke centers (CSC), primary stroke centers (PSC) and a minimum level required for any hospital ward (AHW) admitting stroke patients. Hospitals providing even less than that were indicated in the ‘none’ category. Results: The present survey was conducted in 178 (166 and 12) German and Austrian hospitals which returned the questionnaire (41% response rate). They treated a total of 54,257 acute stroke patients per year (25% of all strokes in Germany and Austria), with a mean of 376 patients per year per hospital. 2,168 patients were given recombinant tissue plasminogen activator (4.7%), a proportion much higher than the pan-European average, but strongly dependent on the level of the facility considered (range 7.5–1.3%). Criteria for CSC were met in 13 hospitals (7.3%), for PSC in 15 (8.4%) and for AHW in 85 (47.7%). The minimum level required for AHW was not met in 65 hospitals (36.5%). 15.7% of German and Austrian hospitals provide stroke center facilities at the CSC or PSC level, as compared with 8.5% in Europe. A 24-hour availability of a stroke-trained physician was met by 100% of CSC, 73% of PSC, 85% of AHW and by 62% at the ‘none’ level of care. At the levels of CSC and PSC, a 100% availability was achieved for multidisciplinary stroke team, stroke-trained nurses, in-house emergency department, physiotherapy and speech therapy within 2 days, 24-hour brain CT and CT or MR angiography, as well as for transesophageal echocardiography and automated 24-hour monitoring of vital parameters. Nearly all these hospitals had training programs, stroke pathways, thrombolysis protocols and prevention procedures in place for the acute care of stroke patients. Conclusions: This survey shows that the minimum level of care is met in Germany and Austria in 63% of hospitals treating stroke patients, whereas the European average is 48.6%. However, the lack of stroke center coverage should encourage health policy decision makers to further improve the infrastructure for acute stroke care in order to make stroke centers available to every stroke victim.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

European Stroke Facilities Survey: The German and Austrian Perspective

et al. 2008

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“…The members of the writing group compiled these items, after having reviewed the relevant literature. Items were, in part, based on the publication by the American Stroke Association on requirements for stroke centres [18, 19] as well as the German and French recommendations from the German and French Stroke Societies [14, 15, 20, 21]. The same questions were applied 3 times, i.e.…”

Section: Methodsmentioning

confidence: 99%

“…Stroke care provided by an organized and dedicated team, and use of stroke care maps lead to shorter hospital stays, fewer complications and a better functional outcome [8,9,10,11], without clear influence of the specialty [12]. For these reasons, the European Stroke Initiative (EUSI) has published recommendations for stroke care stating that stroke patients should be treated in stroke units [13], partly based on international initiatives and recommendations [14, 15]. Although there is an agreement that stroke units are units dedicated exclusively to stroke patients with a multidisciplinary approach [1, 13], the term stroke unit includes various types of facilities [13], and there are only little evidence-based data on which components should be present in different types of stroke units [13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

“…For these reasons, the European Stroke Initiative (EUSI) has published recommendations for stroke care stating that stroke patients should be treated in stroke units [13], partly based on international initiatives and recommendations [14, 15]. Although there is an agreement that stroke units are units dedicated exclusively to stroke patients with a multidisciplinary approach [1, 13], the term stroke unit includes various types of facilities [13], and there are only little evidence-based data on which components should be present in different types of stroke units [13,14,15,16]. A survey of the 11 trials published between 1985 and 2000 which had demonstrated a beneficial effect of stroke unit care found similar approaches in most of them concerning assessment procedures, early management policies and ongoing rehabilitation policies [12].…”

Section: Introductionmentioning

confidence: 99%

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The Main Components of Stroke Unit Care: Results of a European Expert Survey

Leys

Kaste

et al. 2007

Cerebrovasc Dis

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Background and Purpose: Stroke units decrease mortality, handicap and need for institutional care, but there are only sparse evidence-based data showing which components make the difference over general wards. The aim of this survey was to identify from expert opinions what should be the major components of stroke units. Methods: A questionnaire was sent to 83 European stroke experts, to ask their opinion on what should be the components of comprehensive stroke centres (CSC), primary stroke centres (PSC) and any hospital ward (AHW) admitting acute stroke patients routinely. It consisted of a list of 107 components (personnel, diagnostic procedures, monitoring, invasive treatments provided, infrastructures, protocols and procedures and their availability for 24 h a day for 7 days a week, 24/7) to be classified as irrelevant, useful but not necessary, desirable, important but not absolutely necessary, or absolutely necessary. Results: 42 questionnaires (50.6%) were returned. Four components were excluded because of a poor level of agreement between experts. Eight components were considered as absolutely necessary by more than 75% of the experts for both CSC and PSC: multidisciplinary team, stroke-trained nurses, brain CT scan 24/7, CT priority for stroke patients, extracranial Doppler sonography, automated electrocardiographic monitoring, intravenous rt-PA protocols 24/7 and in-house emergency department. Eleven other components (in the fields of vascular surgery, neurosurgery, interventional radiology and clinical research) were considered as necessary in CSC by more than 75% of the experts. Only 8 components were considered as important but not absolutely necessary by more than 50% of the experts for AHW. Conclusion: The experts showed a high level of agreement about the essential components of organized acute stroke care, providing useful information to health authorities for the allocation of resources.

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Vaskuläre Erkrankungen

Kitzrow

Sturm

2023

Arztbriefe in Der Neurologie

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Konzept der überregionalen und regionalen Schlaganfallversorgung in Deutschland

Cited by 20 publications

References 0 publications

European Stroke Facilities Survey: The German and Austrian Perspective

European Stroke Facilities Survey: The German and Austrian Perspective

The Main Components of Stroke Unit Care: Results of a European Expert Survey

Vaskuläre Erkrankungen

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