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STROKE UNITS IN THE CZECH REPUBLIC – CURRENT SITUATION

STROKE UNITS IN THE CZECH REPUBLIC – CURRENT SITUATION. MUDr.Daniel Václavík Ostrava Vítkovice Hospital. ISCHEMIC STROKE ( IS ). -Disease incidence amounts to 280 strokes people out of 100 , 000 yearly. -This ranks us among one of the first places in Europe.

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STROKE UNITS IN THE CZECH REPUBLIC – CURRENT SITUATION

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  1. STROKE UNITS IN THE CZECH REPUBLIC – CURRENT SITUATION MUDr.Daniel Václavík Ostrava Vítkovice Hospital

  2. ISCHEMIC STROKE ( IS ) -Disease incidence amounts to 280 strokes people out of 100,000 yearly. -This ranks us among one of the first places in Europe. -Stroke is in CZ the most frequent cause of death and invalidity. -Death rate among people older than 65 years is double in CZ compared to other EU states. -CZ pledged at Helsingborg Conference together with other states to decrease mortality till 2005 under 40%.

  3. System Measures 1/ organization of pre-hospital care 2/ establishing stroke units /SU/ and stroke centers /SC/ 3/ establishing specialized outpatients' departments to ensure primary and secondary prevention

  4. Advantages of Specialized Care at an Stroke Unit -Random studies proved that hospitalization and care at SU reduce mortality and no. of independent patients by up to 30% compared to hospitalizations at a standard department -decreasing total cost of treatment - shorter hospitalization, smaller number of complications

  5. Required Number of SU Beds • IS incidence 280/100,000 • 28,000 IS in the Czech Rep./year • 4 beds per 100,000 inhabitants are needed when hospitalizing 70% of strokes,with average SU time of 5 days and utilized 70 % • Approx. 30% strokes – hospitalization at other departments for severe other disease or impossibility to improve patient´s prognosis (recurrent stroke with Rankin score higher than 4)

  6. Minimum Criteria for an SU • Delivery time max. 90 minutes • Appliances and technical equipment meeting Czech criteria for intensive care • Therapy and patient´s care by a neurologist, available 24/7 • CT, lab 24/7 • Vessels examination (at least one of: ultrasound,CTA,MRA), minimum surgery hours Mo – Fr, better 24 hrs every day • Sufficient numbers of minimum 100,000 with the goal to treat at least 280 ÍS/year

  7. General Medical Measures with STROKE -monitoring vital functions -pulmonary embolism and deep venous thrombosis prevention -treatment of cardiac disorders, hyperglycemia, fever,elecrolyte disturbances -prevention and treatment of bronchopneumonia -pressure sores prevention -from the second day of hospitalization active rehabilitation, possibly logopedics care -after complex stabilization transfer to a standard department

  8. Cerebrovascular Team - Minimum Parts of team are the following : - neurologists - radiologists - internists (kardiologist) - rehabilitation therapist - speech therapist - educated medical staff ( nursing care )

  9. Cerebrovascular Team – Stroke Centre Parts of team are the following: - neurologists - radiologists - internists, cardiologists - interventional neuroradiologist - neurosurgeon - vascular surgeon - rehabilitation therapist - speech therapist - educated medical staff ( nursing care ) - psychologist

  10. Goal 1. Identify no. of strokeunits ( SU ) in CZ 2. Analyze percentage of SUin neurological departments and general internal depertements and no of trombolysing units 3. Identify no. of stroke beds in individual regions 4. Find out how many thrombolysis are carried out in individual regions out of potential 4 % of patients suitable for thrombolysis 5. Identify stroke beds effectivity in connection with thrombolysis in individual regions – ration of stroke beds and no. of thrombolysis 6. Comparison of years 2006 and 2007

  11. Methodology • Data sources • Czech Statistic Office – no. of inhabitants in regions • Stroke questionnaire – sent to all head physicians of neurological departments • Study by company Boehringer – questionnaires at departments • Trombolytic SITS register • List of neurological departments • SU questionnaire of Ministry of Health

  12. Results

  13. Neurological departments

  14. STROKE beds – neurologic + general

  15. Thrombolysing SU June 2006 upper chart, June 2007 down chart

  16. SU thrombolysig more than 10 pat/year June 2006 upper chart, June 2007 down chart

  17. Required numbers of stroke beds as per regions, in %, 2006

  18. Required numbers of stroke beds as per regions, in %, in 2007

  19. Thrombolysis percentage 2006

  20. Thrombolysis percentage 2007

  21. Beds effectivity coefficient % thrombolysis / % stroke beds 2006

  22. Beds effectivity coefficient % thrombolysis / % stroke beds 2007

  23. Conclusion • In 2006 at least 33% stroke beds missing (reported data include also beds with patients having other than IS diagnosis) • 2007 increased the number of stroke beds by 3% • Generally low percentage of thrombolysed patients , 0.88 % of all IS in 2006 – more than doubled to 1.88 % of all IS in 2007 • In 8% of districts more than 10 throbolysis were done in 2006, in 2007 already 31 % of all SU

  24. Conclusion • Huge unevenness among no. of strokebeds in individual regions • Huge unevenness among numbers of thrombolysed patients as well as in stroke units effectivity • Increase of thrombolysed patients(2.13 times) and functiong stroke units with thrombolysis higher than 10 pacients per year (3.87 times)

  25. THANK YOU FOR YOUR ATTENTION

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