Abstract
Background and Purpose: The effectiveness of organized stroke care on stroke mortality and morbidity remains uncertain. We examined whether organized stroke care index (OCI), which graded 0-3 based on the presence of rehabilitation, stroke team assessment, and admission to a stroke unit developed by Saposnik (Neurology 2010) influence in-hospital mortality and morbidity of patients with ischemic and hemorrhagic stroke in a nationwide study. Methods: Of the 1369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding comprehensive stroke care capacities. Among the institutions that responded, data on patients hospitalized between April 1, 2010 and March 31, 2011, because of stroke were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality morbidity was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, and the number of OCI fulfilled in each component and in total.It was supported by Grants-in-Aid from the Ministry of Health, Labour and Welfare of Japan Results: Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Patients fulfilled the criteria for admission to a SCU, stroke team assessment and the presence of rehabilitation were 28.9%, 42.1% and 95.1%, respectively. Mortality adjusted for age, sex, and level of consciousness was significantly correlated with admission to a SCU (OR=0.87, p=0.039), SCU team assessment (OR=0.88,p=0.029), and OCI ( OR=0.93, p=0.031). Modified ranking scale 0 to 2 rate were also associated with significantly SCU admission (p=0.003) .These association holds for ischemic stroke and subarachnoid hemorrhage. Conclusion: A strong association between organized stroke care and lower mortality was apparent. These data suggest that organized stroke care should be provided to stroke patients regardless of stroke subtype.
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