Abstract
BackgroundAlthough the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances.MethodsOf the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education. Consistency and validity were examined using correlation coefficients and factorial analysis.ResultsThe CSC score (median, 14; interquartile range, 11–18) varied according to hospital volume. The five subcategories showed moderate consistency (Cronbach’s α = 0.765). A strong correlation existed between types of available personnel and specific expertise. Using the 2011 Japanese Diagnosis Procedure Combination database for patients hospitalized with stroke, four constructs were identified by factorial analysis (neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and neurocritical care and rehabilitation) that affected in-hospital mortality from ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The total CSC score was related to in-hospital mortality from ischemic stroke (odds ratio [OR], 0.973; 95% confidence interval [CI], 0.958–0.989), intracerebral hemorrhage (OR, 0.970; 95% CI, 0.950–0.990), and subarachnoid hemorrhage (OR, 0.951; 95% CI, 0.925–0.977), with varying contributions from the four constructs.ConclusionsThe CSC score is a valid measure for assessing CSC capabilities, based on the availability of neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and critical care and rehabilitation services.
Highlights
The Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking
Predictive validity Using the Japanese Diagnosis Combination Procedure (DPC) database for patients hospitalized with strokes during the 2011 fiscal year, we examined the differential effects of the items on mortality and poor outcomes associated with ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)
Median (IQRa) Tissue plasminogen activator Intra-arterial thrombolysis/percutaneous angioplasty Carotid endarterectomy Carotid stenting Extracranial-intracranial bypass surgery Clipping of intracranial aneurysm Coiling of intracranial aneurysm Craniotomy hematoma removal Stereotactic hematoma removal Endoscopic hematoma removal ainterquartile range of ICH (6), intravenous infusion of recombinant tissue plasminogen activator (5), and coiling of Intracranial aneurysm (IA) (3)
Summary
The Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances. The public health implications of stroke care globally, including in Japan, are profound. Despite accelerating progress in stroke therapy, implementation of appropriate acute. In 2010, we started the J-ASPECT study (Nationwide survey of Acute Stroke care capacity for Proper dEsignation of Comprehensive stroke cenTer in Japan) to establish optimal nationwide implementation of stroke centers to improve acute stroke outcomes. We modified the above recommendations to reflect the specific circumstances in Japan and developed a CSC score; this tool was validated using the nationwide Diagnosis Combination Procedure (DPC) database, created during the first year of this study
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