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Tables
Characteristics CSC(n=2,462) LSU(n=726) P-value Female sex, n (%) 1,051 (42.7) 367 (50.6) <0.001 Age in years, mean (SD) 68.62±14.21 73.82±12.14 <0.001 Stroke type, n (%) <0.001 TIA 408 (16.6) 168 (23.1) Intracranial hemorrhage 436 (17.7) 28 (3.8) Ischemia 1,618 (65.7) 530 (7.3) Comorbidities, n (%) Prior stroke 625 (25.4) 194 (26.7) 0.469 Arterial hypertension 1,930 (78.4) 641 (88.3) <0.001 Diabetes mellitus 593 (24.1) 200 (27.5) 0.063 Atrial fibrillation 534 (21.7) 211 (29.1) <0.001 Hypercholesterolemia 820 (33.3) 517 (71.2) <0.001 pmRS, median (IQR) 0 (0-2) 1 (0-2) <0.001 pmRS, n (%) <0.001 0 1435 (58.3) 333 (46.9) 1 398 (16.2) 162 (22.3) 2 323 (13.1) 100 (13.8) 3 213 (8.7) 83 (11.4) 4 84 (3.4) 39 (5.5) 5 9 (0.4) 9 (1.2) Referral to hospital, n (%) <0.001 Self 370 (15.0) 171 (23.6) Emergency services 1049 (42.6) 232 (32.0) Other hospital 627 (25.5) 124 (17.2) Primary care physician 346 (14.1) 179 (24.7) In-house stroke 70 (2.8)) 19 (2.6) CSC - comprehensive stroke centers, LSU - local stroke unit, IQR - interquartile range, pmRS - pre-stroke modified rankin scale, mRS - modified rankin score; PCP - primary care physician, TIA - transient ischemic attack Characteristics CSC(n=2,462) LSU(n=726) P-value mRS at admission, median (IQR) 3 (2-5) 2 (1-4) <0.001 mRS at admission <0.001 0 226 (9.2) 90 (12.4) 1 250 (10.2) 127 (17.5) 2 405 (16.5) 170 (23.4) 3 518 (21.0) 152 (20.9) 4 445 (18.1) 117 (16.1) 5 618 (25.1) 70 (9.6) NIHSS, mean (SD) 7.69 ± 8.98 4.01 ± 5.56 <0.001 NIHSS on admission* <0.001 4-25 1,139 (48.5) 242 (33.9) 1-3 or >25 856 (36.4) 295 (41.4) 0 354 (15.1) 176 (24.7) Admission ward <0.001 Normal ward 146 (5.9) 17 (2.3) Stroke Unit 1,832 (74.4) 693 (95.5) ICU 484 (19.7) 16 (2.2) Door-to-image-time <0.001 ≤30 min 736 (37.5) 120 (22.3) >30 min 1,227 (62.5) 417 (77.7) Image before admission 385 (15.6) 160 (22.0) Modality of first image 0.058 CT 2,002 (81.3) 612 (84.3) MRI 430 (17.5) 111 (15.3) None/not documented 30 (1.2) 3 (0.4) Intravenous thrombolysis None 2031 (82.9) 693 (95.9) After admission 367 (15.0) 30 (4.1) Before admission 53 (2.2) 0 (0) Door-to-needle time <0.001 ≤60min 287 (68.7) 9 (29.0) >60 min 131 (31.3) 22 (71.0) Symptomatic ICH 36 (8.1) 2 (6.5) 0.537 Values are presented as number and percentage (%). CSC - comprehensive stroke centers, LSU - local stroke unit mRS - modified Rankin Score; NIHSS - National Institute for Health Stroke Scale; ICU - intensive care unit, i.v. - intravenous; iICH - intracranial hemorrhage. Some of the values may not add up to the total number of patients included due to missing values* (namely, for patients with in-house stroke no “door”-time could be calculated) Characteristics CSC(n=2462) LSU(n=726) P-value TTE/TEE 1,888 (76.7) 631 (86.9) <0.001 Neurosonography IC 2,257 (91.7) 655 (90.2) 0.230 EC 2,227 (90.5) 678 (93.4) 0.014 Symptomatic ICA stenosis 252 (10.2) 42 (5.8) <0.001 Thrombosis prophylaxis 2,328 (95.0) 558 (77.2) <0.001 PFI <48 hour 1,611 (65.7) 539 (74.6) <0.001 PFI at discharge 1,446 (59.0) 493 (68.2) <0.001 (Planned) anticoagulant 573 (23.4) 205 (28.4) 0.007 Complications All complications 375 (15.3) 59 (8.2) <0.001 Pneumonia 120 (4.9) 25 (3.4) 0.10 Thrombosis/pulmonary embolism 5 (0.0) 1 (0.0) 0.99 Others 283 (11.5) 40 (5.5) <0.01 Discharge modality <0.001 Home 1,208 (49.0) 490 (67.5) Rehabilitation 269 (10.9) 136 (18.7) Other hospital 781 (31.7) 48 (6.6) Nursing home 1 (0.0) 23 (3.2) Other 203 (8.2) 29 (4.0) Intrahospital mortality 202 (8.2) 26 (3.6) <0.001 Mean length of stay (days), mean ± SD 6.19 ± 7.24 7.06 ± 5.03 0.002 Values are presented by number and percentage (%). CSC - comprehensive stroke centers, LSU - local stroke unit, TTE/TEE -transthoracic or transesophageal echocardiogram, IC - intracranial, EC - extracranial, ICA - internal carotid artery, PFI - platelet function inhibitor - Table 4
Association of patient characteristics and stroke service level with quality metrics (binary regression analysis, adjusted for stroke service level).
Characteristics P-value Odds ratio Lower CI Upper CI Intravenous thrombolysis rate after admission to the emergency room (yes versus no) Baseline characteristics Age <0.001 1.020 1.011 1.028 Gender 0.100 1.196 0.966 1.482 pmRS 0.516 1.029 0.943 1.124 Admission type <0.001 0.735 0.658 0.823 Symptoms/severity of stroke at admission NIHSS <0.001 1.044 1.033 1.055 Consciousness* 0.014 0.743 0.586 0.943 Paresis <0.001 1.583 1.397 1.694 Aphasia <0.001 1.418 1.199 1.677 Dysarthria <0.001 1.840 1.559 2.172 Duration of symptoms (<1 h; 1-24 h; >24 h) <0.001 2.856 2.141 3.810 Hospital (LSU versus CSC)† <0.001 0.240 0.163 0.351 Door-to-image-time >30 minutes Baseline characteristics Age <0.001 0.988 0.982 0.995 Gender 0.833 0.982 0.830 1.162 pmRS 0.002 0.899 0.841 0.961 Admission type <0.001 1.182 1.090 1.283 Symptoms/severity of stroke at admission NIHSS <0.001 0.944 0.934 0.954 Consciousness* <0.001 0.745 0.630 0.879 Paresis <0.001 0.654 0.603 0.709 Aphasia <0.001 0.668 0.578 0.772 Dysarthria <0.001 0.520 0.452 0.598 Duration of symptoms (<1 h; 1-24 h; >24 h) <0.001 0.687 0.602 0.783 Hospital (LSU versus CSC)† <0.001 2.084 1.668 2.604 Door-to-needle-time >1 hour Baseline characteristics Age 0.666 0.997 0.983 1.011 Gender 0.921 1.021 0.684 1.523 pmRS 0.141 1.136 0.958 1.347 Admission type 0.157 1.222 0.926 1.612 Symptoms/severity of stroke at admission NIHSS <0.001 1.050 1.023 1.077 Consciousness* <0.001 2.349 1.552 3.557 Paresis 0.220 1.154 0.918 1.452 Aphasia <0.001 1.927 1.348 2.754 Dysarthria 0.221 1.264 0.868 1.842 Duration of symptoms (<1 h; 1-24 h; >24 h) 0.043 0.534 0.290 0.981 Hospital (LSU versus (SC)† <0.001 5.355 2.400 11.950 CSC - comprehensive stroke centers, LSU - local stroke unit, pmRS - prestroke modified Rankin Scale, NIHSS - National Institute of Health Stroke Scale
*awake, drowsie, comatose; †unadjusted, included for comparison
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