Abstract 15: Differential Impact of Comprehensive Stroke Care Capacity on in-Hospital Mortality After Stroke-j-aspect Study

Abstract

Background: The effectiveness of comprehensive stroke center (CSC) capacities on stroke mortality remains uncertain. We examined whether specific CSC capacities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke in a nationwide study. Methods and Results: Of 749 certified training institutions in Japan responded to a questionnaire survey regarding CSC capacities, specifically regarding the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs, 265 institutions agreed to participate in this study. Data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, and 25 fulfilled CSC items in each component. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with different items in the five components recommended for CSC depending on stroke types (Table 1 and 2). Conclusions: CSC capacities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on the type of stroke.