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Justus-Liebig-University of Giessen

Justus-Liebig-University of Giessen. Dpt. of Neurology. Stroke Management in Germany. Dr. Jens Allendoerfer Dpt. of Neurology University Hospital of Gießen (Head: Prof. Dr. M. Kaps). Bloodletting. Justus-Liebig-University of Giessen. Dpt. of Neurology. built in 1890. Since 1995

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Justus-Liebig-University of Giessen

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  1. Justus-Liebig-University of Giessen Dpt. of Neurology Stroke Management in Germany Dr. Jens Allendoerfer Dpt. of Neurology University Hospital of Gießen (Head: Prof. Dr. M. Kaps)

  2. Bloodletting Justus-Liebig-University of Giessen Dpt. of Neurology built in 1890

  3. Since 1995 Prospective data collection for quality assurance and development of marker of quality in stroke care* *Heuschmann et al, Stroke 2006;37;2573-2551 100 years later… >150stroke units in the states of Germany In the early 90s: Development of the german stroke unit concept and implementation in stroke care, supported by the public health system

  4. Stroke Unit in Germany • Central reading • Blood pressure • Heart rate • ECG with automated arrhythmia detection • Oxygen saturation • Breathing rate • Temperature • Equipment • Monitor • Oxygen • Suction devices

  5. Optimized management of care with a Stroke Unit Emergency medical service gives basic information by call Emergency dpt. CCT or MRI Stroke Unit 10 20 30 40 Minuten rtPA Neurologist on duty Anamnesis, clinical status, Lab (EKG, Ultrasound) CCT or DWI MRI (CTAngio, DSA, Xray) Stroke TEAM treatment Basic therapy Monitoring further diagnostics

  6. Advantages of a Stroke Unit • Admission as early as possible • Organisation of emergency medical service • Specialized staff • Fast diagnosis • Modern treatment strategies • Short hospital stay • Early physio- and speechtherapy • Early Rehabilitation

  7. Admission • demographic data • Time of stroke, of admission • clinical scales like NIHSS & mRS before admission • dependency status • Hospital inpatient stay • diagnostic procedures • medical treatment & additional procedures • complications • duration of symptoms • Stroke classification according to TOAST • Findings of MRI and CT scan • End of inpatient treatment • secondary prophylaxis (antiplatelets, statins…) • diagnosis according to ICD-10 • clinical scales like NIHSS, mRS, Barthel Index • rehabilitation status (discharge or appointment for rehab.)

  8. Sanctions in case of incomplete documentation • Data were compared with ICD data of the health insurance • If the rate of QA documentation is below 80% a reduction of payment follows • These mechanisms provides a nearly complete documentation of stroke patients Scientific evaluation A data core set of all QA documentations in the different states of germany is given to the ADSR (German Stroke Register Study Group) for further evaluation

  9. male female 21.350 stroke patients (2006 in Hesse) Mean age 73.3y Age

  10. Hospital arrival after stroke

  11. Risk factors 89% of all patients have at least one risk factor % of patients in history

  12. Diagnostic in acute stroke

  13. Diagnoses in Stroke 5% unk ICH TIA Infarction 61%

  14. Early treatment in acute stroke (only patients with cerebral infarction, n=13129) 3,5% 65% 16% 78%

  15. Thrombolysis in acute stroke (pat. with cerebral infarction arrived within 3h, n=2402) rate of 19,3%

  16. End of hospital treatment (n=21.350) • Length of stay: 9,5 days (mean) • Treatment on the Stroke Unit: 3,9 days (mean) Discharge • Home 50% • Inpatient Rehabilitation 29% • Nursing home 6% • died in hospital 6%

  17. Useful data or waste? 1. Jauss M, Allendoerfer J, Stolz E, Schutz HJ, Misselwitz B. Treatment results of stroke patients aged >80 years receiving intravenous rt-PA. Cerebrovasc Dis 2007;24(2-3):305-6. 2. Foerch C, Misselwitz B, Humpich M, Steinmetz H, Neumann-Haefelin T, Sitzer M. Sex disparity in the access of elderly patients to acute stroke care. Stroke 2007;38(7):2123-6. 3. Foerch C, Misselwitz B, Sitzer M, Berger K, Steinmetz H, Neumann-Haefelin T. Difference in recognition of right and left hemispheric stroke. Lancet 2005;366(9483):392-3. 4. Sitzer M, Foerch C, Neumann-Haefelin T, Steinmetz H, Misselwitz B, Kugler C, Back T. Transient ischaemic attack preceding anterior circulation infarction is independently associated with favourable outcome. J Neurol Neurosurg Psychiatry 2004;75(4):659-60. 5. Suenkeler IH, Nowak M, Misselwitz B, Kugler C, Schreiber W, Oertel WH, Back T. Timecourse of health-related quality of life as determined 3, 6 and 12 months after stroke. Relationship to neurological deficit, disability and depression. J Neurol 2002;249(9):1160-7. And some more papers by the ADSR were supported by the stroke registry of Hesse (Heuschmann et. al….Stroke 2003, JAMA 2004, Arch Int Med 2004, Stroke 2006, )

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