Hospital management of acute ischemic stroke in China

Abstract

Hospital management of acute ischemic stroke varies greatly within and between different countries. This study assesses the current practices and opinions of doctors in China routinely involved in the treatment of stroke, and compares them with those of British doctors. Questionnaires about the usual management of acute ischemic stroke were sent to 247 Chinese hospitals (mostly urban) collaborating in an acute stroke trial, seeking responses from five doctors (one consultant, two registrars, and two house officers) in each. After one mailing, 1,095 doctors (89%) responded. Sixty-nine percent of the hospitals had computed tomography scanners, and 88% of the doctors in those hospitals reported that they would routinely scan acute stroke patients (78% usually within 24 hours of admission and 22% only later). Sixty-two percent of doctors reported average hospital stays of 2 to 4 weeks, whereas 36% reported longer average stays. Treatments reported to be used routinely within the first 48 hours of acute ischemic stroke included glycerol or mannitol (69% of doctors), Chinese herb products (66%), calcium antagonists (54%), and aspirin (53%); for each of these treatments, over 70% of all doctors believed it produced definite benefit. Reported routine use of dextran (44%), snake venom (32%), "photo-therapy" (22%), and steroids (19%) was also moderately common, and about half of all doctors believed each was beneficial. In contrast, routine use of thrombolytic agents (4%) or anticoagulants (1%) was uncommon. Only one third of the doctors reported active treatment of hypertension immediately after admission. Comparison with a similar survey in Britain showed reported use of most treatments for acute ischemic stroke was more extensive in China, but that within both countries there was wide variation. The substantial variations in clinical practice both within and between China, the United Kingdom and other countries reflect, at least in part, the substantial uncertainty about the effectiveness of many of the possible treatments for acute ischemic stroke. Large-scale randomized evidence is needed to confirm or refute the efficacy of these and newer treatments for acute stroke.