Background
The association between comprehensive stroke care capacity and hospital volume of
stroke interventions remains uncertain. We performed a nationwide survey in Japan
to examine the impact of comprehensive stroke care capacity on the hospital volume
of stroke interventions.
Methods
A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA)
protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure,
and educational components recommended for comprehensive stroke centers (CSCs) was
sent to 1369 professional training institutions. We examined the effect of hospital
characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total
CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage,
and coiling and clipping of intracranial aneurysms performed in 2009.
Results
Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols
(85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel
(eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic
(eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping
and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg,
intensive care unit: 63.9% versus 33.9%), and education (eg, professional education:
65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics,
total CSC score, but not having a t-PA protocol, was associated with the volume of
all types of interventions with a clear increasing trend (P for trend < .001).
Conclusion
We demonstrated a significant association between comprehensive stroke care capacity
and the hospital volume of stroke interventions in Japan.
Key Words
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Article info
Publication history
Published online: October 07, 2013
Accepted:
August 21,
2013
Received in revised form:
August 8,
2013
Received:
May 16,
2013
Footnotes
Conflict of interest: None declared.
This study was supported by Grants-in-Aid from the Ministry of Health, Labor, and Welfare of Japan (principal investigator: KI).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.08.016
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
