Akiko Kada1, Kuniaki Ogasawara2, Takanari Kitazono3, Kunihiro Nishimura4, Nobuyuki Sakai5, Daisuke Onozuka6, Yoshiaki Shiokawa7, Shigeru Miyachi8, Izumi Nagata9, Kazunori Toyoda10, Yoichiro Hashimoto11, Yasuhiro Hasegawa12, Haruhiko Hoshino13, Shinichi Yoshimura14, Michiyasu Suzuki15, Akira Tsujino16, Shinya Matsuda17, Ryota Kurogi18, Ai Kurogi18, Nice Ren18, Ataru Nishimura18, Koichi Arimura18, Akihito Hagihara6, Teiji Tominaga19, Takamasa Kayama20, Hajime Arai21, Norihiro Suzuki22, Susumu Miyamoto23, Akira Ogawa2, Koji Iihara18. 1. Department of Clinical Research Management, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan. 2. Department of Neurosurgery, Iwate Medical University, Morioka, Japan. 3. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 4. Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan. 5. Department of Neurosurgery, Kobe City General Hospital, Kobe, Japan. 6. Department of Health Communication, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 7. Department of Neurosurgery, Kyorin University, Mitaka, Japan. 8. Department of Neurosurgery, Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Japan. 9. Department of Neurosurgery, Kokura Memorial Hospital, Kita-Kyushu, Japan. 10. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. 11. Department of Neurology, Kumamoto City Hospital, Kumamoto, Japan. 12. Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan. 13. Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan. 14. Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan. 15. Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan. 16. Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan. 17. Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan. 18. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 19. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 20. Department of Advanced Medicine, Yamagata University School of Medicine, Yamagata, Japan. 21. Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan. 22. Department of Neurology, Shonan Keiiku Hospital, Fujisawa, Japan. 23. Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Abstract
BACKGROUND: Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. AIMS: To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. METHODS: This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1-25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3-6) at discharge were examined using hierarchical logistic regression models. RESULTS: Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010-2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95-0.99), 0.97 (0.95-0.998), 1.07 (1.04-1.10), and 1.21 (1.14-1.28), respectively). CONCLUSIONS: This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.
BACKGROUND: Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic strokepatients exists. AIMS: To examine trends in in-hospital outcomes of acute ischemic strokepatients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. METHODS: This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic strokepatients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1-25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3-6) at discharge were examined using hierarchical logistic regression models. RESULTS: Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010-2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95-0.99), 0.97 (0.95-0.998), 1.07 (1.04-1.10), and 1.21 (1.14-1.28), respectively). CONCLUSIONS: This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.
Entities:
Keywords:
Ischemic stroke; in-hospital mortality; stroke center