Ｓｔｒｏｋｅ Ｕｎｉｔの現状と課題：急性期脳卒中診療体制に関する全国アンケート調査から

Abstract

Guideline for Stroke Treatment 2004 published in Japan strongly recommended that acute stroke patients should be managed in dedicated stroke care unit or stroke unit. We conducted a nation-wide survey of all hospitals providing acute stroke care. We sent a questionnaire to 7, 835 hospitals and obtained 2, 603 answers (33.2%). According to the meta-analysis by Stroke Unit Trialists' Collaboration, service organizations were classified into five categories as a hierarchy in descending order as follows ; acute stroke units, comprehensive stroke units, mixed rehabilitation ward, mobile stroke team, and general medical ward. Only 8.3% of hospitals had organized stroke units (acute stroke units ; 0.9%, comprehensive stroke units ; 7.4%), and 63.8% of hospitals managed acute stroke patients in general medical words. The categorization of stroke service organizations was highly correlated with the number of patients admitted in a year. We compared performance levels of the key elements recommended for establishing primary stroke centers by the Brain Attack Coalition among the five categories, such as acute stroke teams, stroke units, written care protocols, and an integrated emergency response system, availability and interpretation of computed tomography scans 24 hours everyday, access to neurosurgeon within 2 hours and rapid laboratory testing. Currently there are very few hospitals with performance levels required for the primary stroke center. More importantly, measures were taken for the quality improvement of stroke care only by 6.5% of hospitals. Intravenous thrombolytic therapy is now widely available in Japan. Establishment of clearly defined stroke units or stroke care units is urgently needed.