Effectiveness of Primary and Comprehensive Stroke Centers PERFECT Stroke: A Nationwide Observational Study From Finland
Previous studies show better outcomes for patients with stroke receiving care in stroke units, but many different stroke unit criteria have been published. In this study, we explored whether stroke centers fulfilling standardized Brain Attack Coalition criteria produce better patient outcomes than h...
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| Veröffentlicht in: | Stroke (1970) 2010-06, Vol.41 (6), p.1102-1107 |
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| creator | MERETOJA, Atte ROINE, Risto O SIVENIUS, Juhani HÄKKINEN, Unto KASTE, Markku LINNA, Miika ROINE, Susanna JUNTUNEN, Merja ERILÄ, Terttu HILLBOM, Matti MARTTILA, Reijo RISSANEN, Aimo |
| description | Previous studies show better outcomes for patients with stroke receiving care in stroke units, but many different stroke unit criteria have been published. In this study, we explored whether stroke centers fulfilling standardized Brain Attack Coalition criteria produce better patient outcomes than hospitals without stroke centers.
We did an observational register-linkage study of all patients with ischemic stroke treated in Finland between 1999 and 2006. After exclusion of recurrent strokes and nonanalyzable patients, we included 61 685 consecutive patients treated in 333 hospitals classified in national audits either as Comprehensive Stroke Centers, Primary Stroke Centers, or General Hospitals according to Brain Attack Coalition criteria. Primary outcome measures were case-fatality and being in institutional care 1 year after stroke.
Care in stroke centers was associated with lower 1-year case-fatality and reduced institutional care compared with General Hospitals. The number-needed-to-treat to prevent 1 death or institutional care at 1 year was 29 for Comprehensive Stroke Centers and 40 for Primary Stroke Centers versus General Hospitals. Patients treated in stroke centers had lower mortality during the entire follow-up of up to 9 years and their median survival was increased by 1 year.
This study shows a clear association between the level of acute stroke care and patient outcome and supports use of published criteria for primary and comprehensive stroke centers. |
| doi_str_mv | 10.1161/STROKEAHA.109.577718 |
| format | Article |
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We did an observational register-linkage study of all patients with ischemic stroke treated in Finland between 1999 and 2006. After exclusion of recurrent strokes and nonanalyzable patients, we included 61 685 consecutive patients treated in 333 hospitals classified in national audits either as Comprehensive Stroke Centers, Primary Stroke Centers, or General Hospitals according to Brain Attack Coalition criteria. Primary outcome measures were case-fatality and being in institutional care 1 year after stroke.
Care in stroke centers was associated with lower 1-year case-fatality and reduced institutional care compared with General Hospitals. The number-needed-to-treat to prevent 1 death or institutional care at 1 year was 29 for Comprehensive Stroke Centers and 40 for Primary Stroke Centers versus General Hospitals. Patients treated in stroke centers had lower mortality during the entire follow-up of up to 9 years and their median survival was increased by 1 year.
This study shows a clear association between the level of acute stroke care and patient outcome and supports use of published criteria for primary and comprehensive stroke centers.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.109.577718</identifier><identifier>PMID: 20395609</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Academic Medical Centers ; Biological and medical sciences ; Disease-Free Survival ; Female ; Finland - epidemiology ; Follow-Up Studies ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Male ; Medical sciences ; Nervous system (semeiology, syndromes) ; Neurology ; Registries ; Retrospective Studies ; Stroke - mortality ; Stroke - therapy ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2010-06, Vol.41 (6), p.1102-1107</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c285t-d66de94ad5ddac06257459599ce44905c38cc089525b4e1c57e93f67c30d40a63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,3674,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22852967$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20395609$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MERETOJA, Atte</creatorcontrib><creatorcontrib>ROINE, Risto O</creatorcontrib><creatorcontrib>SIVENIUS, Juhani</creatorcontrib><creatorcontrib>HÄKKINEN, Unto</creatorcontrib><creatorcontrib>KASTE, Markku</creatorcontrib><creatorcontrib>LINNA, Miika</creatorcontrib><creatorcontrib>ROINE, Susanna</creatorcontrib><creatorcontrib>JUNTUNEN, Merja</creatorcontrib><creatorcontrib>ERILÄ, Terttu</creatorcontrib><creatorcontrib>HILLBOM, Matti</creatorcontrib><creatorcontrib>MARTTILA, Reijo</creatorcontrib><creatorcontrib>RISSANEN, Aimo</creatorcontrib><title>Effectiveness of Primary and Comprehensive Stroke Centers PERFECT Stroke: A Nationwide Observational Study From Finland</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Previous studies show better outcomes for patients with stroke receiving care in stroke units, but many different stroke unit criteria have been published. In this study, we explored whether stroke centers fulfilling standardized Brain Attack Coalition criteria produce better patient outcomes than hospitals without stroke centers.
We did an observational register-linkage study of all patients with ischemic stroke treated in Finland between 1999 and 2006. After exclusion of recurrent strokes and nonanalyzable patients, we included 61 685 consecutive patients treated in 333 hospitals classified in national audits either as Comprehensive Stroke Centers, Primary Stroke Centers, or General Hospitals according to Brain Attack Coalition criteria. Primary outcome measures were case-fatality and being in institutional care 1 year after stroke.
Care in stroke centers was associated with lower 1-year case-fatality and reduced institutional care compared with General Hospitals. The number-needed-to-treat to prevent 1 death or institutional care at 1 year was 29 for Comprehensive Stroke Centers and 40 for Primary Stroke Centers versus General Hospitals. Patients treated in stroke centers had lower mortality during the entire follow-up of up to 9 years and their median survival was increased by 1 year.
This study shows a clear association between the level of acute stroke care and patient outcome and supports use of published criteria for primary and comprehensive stroke centers.</description><subject>Academic Medical Centers</subject><subject>Biological and medical sciences</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Finland - epidemiology</subject><subject>Follow-Up Studies</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Stroke - mortality</subject><subject>Stroke - therapy</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1PGzEQhi3UiqTQf1BVvlScNvW3171Fqw1BIIJIel459qy67X6k9gbEv8claThZnnnesedB6AslM0oV_b7ePK5uy_lyPqPEzKTWmuZnaEolE5lQLP-ApoRwkzFhzAR9ivE3IYTxXJ6jCUsNqYiZoueyrsGNzRP0ECMeavwQms6GF2x7j4uh2wX4BX1MAF6PYfgDuIB-hBDxQ_m4KIvNsfwDz_G9HZuhf2484NU2Qnh6u9s2IXv_ghdh6PCi6ds0-hJ9rG0b4fPxvEA_F-WmWGZ3q-ubYn6XOZbLMfNKeTDCeum9dUQxqYU00hgHQhgiHc-dI7mRTG4FUCc1GF4r7TjxgljFL9DVYe4uDH_3EMeqa6KDNv0Bhn2sNOcpzoxOpDiQLgwxBqir3cFERUn1z3h1Mp4qpjoYT7Gvxwf22w78KfRfcQK-HQEbnW3rYHvXxHcu7cmM0vwV6-yKeQ</recordid><startdate>20100601</startdate><enddate>20100601</enddate><creator>MERETOJA, Atte</creator><creator>ROINE, Risto O</creator><creator>SIVENIUS, Juhani</creator><creator>HÄKKINEN, Unto</creator><creator>KASTE, Markku</creator><creator>LINNA, Miika</creator><creator>ROINE, Susanna</creator><creator>JUNTUNEN, Merja</creator><creator>ERILÄ, Terttu</creator><creator>HILLBOM, Matti</creator><creator>MARTTILA, Reijo</creator><creator>RISSANEN, Aimo</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100601</creationdate><title>Effectiveness of Primary and Comprehensive Stroke Centers PERFECT Stroke: A Nationwide Observational Study From Finland</title><author>MERETOJA, Atte ; ROINE, Risto O ; SIVENIUS, Juhani ; HÄKKINEN, Unto ; KASTE, Markku ; LINNA, Miika ; ROINE, Susanna ; JUNTUNEN, Merja ; ERILÄ, Terttu ; HILLBOM, Matti ; MARTTILA, Reijo ; RISSANEN, Aimo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c285t-d66de94ad5ddac06257459599ce44905c38cc089525b4e1c57e93f67c30d40a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Academic Medical Centers</topic><topic>Biological and medical sciences</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Finland - epidemiology</topic><topic>Follow-Up Studies</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Stroke - mortality</topic><topic>Stroke - therapy</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MERETOJA, Atte</creatorcontrib><creatorcontrib>ROINE, Risto O</creatorcontrib><creatorcontrib>SIVENIUS, Juhani</creatorcontrib><creatorcontrib>HÄKKINEN, Unto</creatorcontrib><creatorcontrib>KASTE, Markku</creatorcontrib><creatorcontrib>LINNA, Miika</creatorcontrib><creatorcontrib>ROINE, Susanna</creatorcontrib><creatorcontrib>JUNTUNEN, Merja</creatorcontrib><creatorcontrib>ERILÄ, Terttu</creatorcontrib><creatorcontrib>HILLBOM, Matti</creatorcontrib><creatorcontrib>MARTTILA, Reijo</creatorcontrib><creatorcontrib>RISSANEN, Aimo</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MERETOJA, Atte</au><au>ROINE, Risto O</au><au>SIVENIUS, Juhani</au><au>HÄKKINEN, Unto</au><au>KASTE, Markku</au><au>LINNA, Miika</au><au>ROINE, Susanna</au><au>JUNTUNEN, Merja</au><au>ERILÄ, Terttu</au><au>HILLBOM, Matti</au><au>MARTTILA, Reijo</au><au>RISSANEN, Aimo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of Primary and Comprehensive Stroke Centers PERFECT Stroke: A Nationwide Observational Study From Finland</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2010-06-01</date><risdate>2010</risdate><volume>41</volume><issue>6</issue><spage>1102</spage><epage>1107</epage><pages>1102-1107</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Previous studies show better outcomes for patients with stroke receiving care in stroke units, but many different stroke unit criteria have been published. In this study, we explored whether stroke centers fulfilling standardized Brain Attack Coalition criteria produce better patient outcomes than hospitals without stroke centers.
We did an observational register-linkage study of all patients with ischemic stroke treated in Finland between 1999 and 2006. After exclusion of recurrent strokes and nonanalyzable patients, we included 61 685 consecutive patients treated in 333 hospitals classified in national audits either as Comprehensive Stroke Centers, Primary Stroke Centers, or General Hospitals according to Brain Attack Coalition criteria. Primary outcome measures were case-fatality and being in institutional care 1 year after stroke.
Care in stroke centers was associated with lower 1-year case-fatality and reduced institutional care compared with General Hospitals. The number-needed-to-treat to prevent 1 death or institutional care at 1 year was 29 for Comprehensive Stroke Centers and 40 for Primary Stroke Centers versus General Hospitals. Patients treated in stroke centers had lower mortality during the entire follow-up of up to 9 years and their median survival was increased by 1 year.
This study shows a clear association between the level of acute stroke care and patient outcome and supports use of published criteria for primary and comprehensive stroke centers.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>20395609</pmid><doi>10.1161/STROKEAHA.109.577718</doi><tpages>6</tpages></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Ovid Autoload; Alma/SFX Local Collection |
| subjects | Academic Medical Centers Biological and medical sciences Disease-Free Survival Female Finland - epidemiology Follow-Up Studies Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Male Medical sciences Nervous system (semeiology, syndromes) Neurology Registries Retrospective Studies Stroke - mortality Stroke - therapy Vascular diseases and vascular malformations of the nervous system |
| title | Effectiveness of Primary and Comprehensive Stroke Centers PERFECT Stroke: A Nationwide Observational Study From Finland |
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