Multicentre collection of uniform data on patients hospitalised for transient ischaemic attack or stroke in the Philippines: the Philippine Neurological Association One Database-Stroke (PNA1DB-Stroke) protocol

Abstract

Introduction For scientific advances to translate into improved patient outcomes, systems of care must be in place to facilitate delivery of care. There is scarce information on quality of care and clinical outcome in our stroke patients. We aim to collect uniform data from patients with first or recurrent transient ischaemic attack (TIA) or ischaemic or haemorrhagic stroke to determine in-patient caseload, patient profile, types of diagnostic and therapeutic procedures, outcomes and overall quality of care among patients hospitalised for acute stroke in the Philippines. Methods and analysis This multicentre observational study and standing database will include patients diagnosed with first or recurrent TIA, ischaemic or haemorrhagic stroke or cerebral venous thrombosis, ≥18 years old, and admitted in any of the country’s 11 accredited adult neurology residency training institutions. Anonymised data on sociodemographics, medical history, stroke subtype, in-hospital management and discharge outcomes will be collected and entered in a database using a secure online data platform. Outcomes include in-hospital complications, functional, neurological and vital (alive or dead) status at discharge. We intend to capture data from all TIA and stroke cases in participating sites. Based on 2017–2019 census, approximately 10 000 cases each year may be included. Collective data spanning 3 years will be extracted, summarised and analysed every year. Ethics and dissemination Approval from ethics committees or institutional review boards (EC/IRB) was obtained from the Single Joint Research Ethics Board and all participating institutions. As this study involves no more than minimal risk to patients, waiver of informed consent was requested. Written information about the study will be provided to patients or legal representative. If site EC/IRB requires written consent, only approved consent forms will be used. To identify areas of improvement and guide public health policies, data on ‘real-world’ situation are needed. The Philippine Neurological Association One Database-Stroke initiative may become a model that can be implemented in other designated stroke-ready hospitals. Trial registration NCT04972058; ClinicalTrials.gov.

Stroke systems of care in the Philippines: Addressing gaps and developing strategies

“…In 2014–2016, the thrombolysis rate ( Figure 3 ) was low at 1.4% of all acute ischemic strokes. Through various stroke training and education in the different areas of the country by the stroke society, the thrombolysis rate increased to 11% in 2021 based on RES-Q database ( 45 ). The Res-Q database is participated by 27 ASRH hospitals but not all stroke cases are encoded as only a minimum of 30 representative cases per quarter are encoded.…”

“…There was a slight decrease in the thrombolysis rate during the COVID pandemic in 2020. The PNA Stroke Database ( 45 ) is participated by 11 Neurology training institutions and encodes all stroke cases seen at the training hospitals. There is a higher thrombolysis rate in the public hospitals ( Table 1 ) since the medicine rTPA is subsidized by the government.…”

“…Of all the acute ischemic strokes patients, 50%−60% in the RES-Q database and 71% in the PNA Database arrive at the ER beyond 3 h from the time of stroke ( Figure 4 ) ( 44 , 45 ).…”

“…Figure 4 , shows the percentage of delayed arrival to hospitals, with missed opportunities for IV thrombolysis. More than 50% of acute stroke patients have a delayed ER arrival time ( 44 , 45 ). The reasons include poor stroke awareness, transportation problems and traffic, transfer from a primary hospital with minimal stroke care and incomplete facilities, overcrowding of public hospitals, lack of organized stroke network and lack of EMS ( 7 ).…”

“…An interoperable national stroke registry across public and private facilities is vital in improving stroke care. The Philippine Neurological Association One Database – Stroke (PNA1DB-Stroke; clinicaltrials.gov NCT04972058) started data collection on 1 June 2021 ( 45 ). This project is supported by the Philippine Neurological Association.…”