Abstract W MP80: Effects of Comprehensive Stroke Care Capabilities on In-hospital Mortality of Patients With Ischemic and Hemorrhagic Stroke: J-ASPECT Study 2010-2013

Abstract

Background: The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. Methods and Results: Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2013 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items (total CSC score). Data from 417 institutions and 21,8579 emergency-hospitalized patients were analyzed. CSC capabilities of the participating hospitals were classified into quintiles (Q1: 2-13, Q2: 14-16, Q3: 17-18, Q4: 19-20, Q5: 21-24). Mortality rates were 4.9% for patients with ischemic stroke, 15% for patients with intracerebral hemorrhage (ICH), and 27% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, hypertension, diabetes mellitus, hyperlipidemia, and level of consciousness was significantly correlated with total CSC scores in patients with ischemic stroke (adjusted OR of Q2-5 compared with that of Q1 as control: 1.06, 0.97, 0.97, 0.88*, respectively, * P<0.01), ICH (adjusted OR of Q2-5 compared with that of Q1 as control: 0.89*, 0.85#, 0.81#, 0.80#, respectively, * P<0.01, #P<0.001) and SAH (adjusted OR of Q2-5 compared with that of Q1 as control: 0.94, 0.96, 0.82*, 0.75#, respectively, * P<0.01,#P<0.001). Conclusions: CSC capabilities were associated with reduced in-hospital mortality rates in all types of stroke.