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Stroke Care in Europe

Stroke Care in Europe. L. Garcia-Castrillo, MD, SEMES Department of Emergency Medicine University Hospital Marques de Valdecilla Cantabria , Spain. Alert ED. Diagnosis & Treatment. EMS Response & Transport. Dispatch. Identification. Stroke Chain of recovery.

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Stroke Care in Europe

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  1. Stroke Care in Europe L. Garcia-Castrillo, MD, SEMES Department of Emergency Medicine University Hospital Marques de Valdecilla Cantabria, Spain

  2. Alert ED Diagnosis & Treatment EMS Response & Transport Dispatch Identification Stroke Chain of recovery Pepe PE. Ensuring the chain of recovery for stroke in your community. Acad Emerg Med 1998;5(4):352-8

  3. Teaching Points to be Addressed • Stroke care in Europe • The role of Emergency Medicine in Stroke care

  4. Setting L. Garcia-Castrillo

  5. Europa • 45 Languages • 43 Countries • 727. Mill. 400 Mill. in EU • 15% >65 years

  6. Stroke in Europe • 3rd Cause of death • 1million of new cases, with 400.000 casualties per year • First cause of disability • Accounts 3-5% of total health cost • Great differences in cost and results

  7. Cerebrovascular Disease: Females per 100,000 < 41.64 < 62.64 < 83.64 < 104.6 < 125.6 ³ 125.6 Adjusted Death rate

  8. Cerebrovascular Disease: Males per 100,000 < 58.33 < 86.33 < 114.3 < 142.3 < 170.3 ³ 170.3 Adjusted Death rate

  9. Stroke Incidence in Europe Charles D.A. Variations in Stroke Incidence and Survival in 3 Areas of Europe. Stroke;31:2074-2079.

  10. Relevant Contributions • WHO Task Force on Stroke and other Cerebrovascular Disorders, 1989; • European Federation of Neurological Societies Task Force, 1997; • European Ad Hoc Consensus Group, 1996; • Pan European Consensus Meeting on Stroke Management, 1995; • EUSI European Federation of Neurological Societies (EFNS), European Neurological Society (ENS) and European Stroke Council (ESC). 2000;

  11. Recommendations Emergency Area • Education • Stroke symptoms • EMS use • Identify Stroke as an emergency medical problem • Use protocols to identify stroke symptoms in the Dispatch Center • Reduce delays in the prehospital phase • Transport to a Hospital with an adequate Stroke Unit • ED • Rapid evaluation • Treat Medical Problems

  12. Results L. Garcia-Castrillo

  13. Variations in Outcomes Chales DA Wolfe. BIOMED Study of Stroke Care Group. Stroke 1999;30:350-356. L. Garcia-Castrillo

  14. European Stroke Care Inventory • 30 EFNS member countries collect information on acute stroke care • 22 countries were represented • Information represents national data M. Brainin. Acute neurological stroke care in Europe: Results of the European Stroke Care Inventory Eu J Neurol 2000;7:5-10

  15. Stroke Management in Europe I

  16. Stroke Management in Europe II

  17. Time to Care L. Serrano Latency time and thrombolitic treatment of ischemic ictus. Emergencias 1998; 10:236-238

  18. Stroke Emergency Care IST Collaborative Group. Variations Between Countries in Outcome After Stroke in International Stroke Trial (IST) Stroke 2001;32:1370-77

  19. Pre-hospital Stroke Care • European Emergency Data Project T.Krafft EED Group Comparing European EMS Systems GEOMED geomed@uni-bonn.de

  20. L. Garcia-Castrillo

  21. EMS Stroke Care Two Systems Comparison P <0.05 EED Project

  22. Period 1998-2000 Cases 2313 Arrive with ALS unit doctor 27% At hospital < 3h 57% CT < 30 min 54% Thrombolysis 4.1% 3 months mortality 12.9% Integrated Network Stroke Care Austrian Steiner MM. The quality of acute stroke units on nation-wide level: the Austrian Stroke Registry for acute stroke units. Eur J Neurol 2003;4:353-60

  23. Teaching Points to be Addressed • Stroke care in Europe • There are important geographical differences between areas; in incidence, process of care and outcomes • Different outcomes can be explained, in part, due to the level of resources available

  24. Teaching Points to be Addressed • The role of Emergency Medicine in Stroke care • EMS is a fundamental part of Stroke care facilitating; access, high level pre-hospital care and integration with in hospital systems • EMS-ED must be part of the concept of Integral Stroke care

  25. Summary • The role of Emergency Medicine in the pre-hospital and in the ED is clearly defined in guidelines and consensus documents • More high quality research is needed to clarify the best model of care

  26. Questions?

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