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Stroke Care in Europe – The Role of Stroke Units
Table 1: Components Considered Absolutely Necessary for a Table 2: Infrastructural Components Considered Absolutely
Comprehensive Stroke Centre by 75% (Bold) or 50% (Normal) of Necessary or Important in the Primary Stroke Centre by More
Experts, Respectively Than 75% (Bold) or 50% (Normal) of Experts
Personnel Multidisciplinary team Personnel Multidisciplinary team
Stroke-trained nurses Stroke-trained nurses
Physiotherapy started within two days Neurologists on call
Neurologists available 24/7 Neurologists on staff
Stroke-trained physician available 24/7 Stroke-trained physician available 24/7
Interventional neuroradiologist on call Diagnostic radiologist on call
Neurosurgeon on call Emergency department staff
CEA vascular surgeon Physician expert in carotid ultrasonology
Emergency department staff Social worker
Physician expert in carotid ultrasonography Speech therapy start within two days
Physician expert in echocardiography Physiotherapy start within two days
Speech therapy start within two days Diagnostic procedures Brain CT scan available 24/7
Physiotherapy start within two days CT priority for stroke patients
Diagnostic procedures Brain CT scan available 24/7 Extracranial Doppler sonography
CT priority for stroke patients Extracranial Duplex sonography
Extracranial Doppler sonography Transthoracic echocardiography
Extracranial duplex sonography Transoesophageal echocardiography
Transthoracic echocardiography Monitoring Automated ECG monitoring at bedside
MRI (T1, T2, T2*, FLAIR) available 24/7 Automated monitoring of pulsoximetry
Diffusion-weighted MRI Automated monitoring of blood pressure
Extracranial Doppler sonography available 24/7 Automated monitoring of breathing
Extracranial duplex sonography available 24/7 Monitoring of temperature
Transcranial Doppler available 24/7 Infrastructures Emergency department (in-house)
CT angiography available 24/7 Stroke outpatient clinic
Magnetic resonance angiography available 24/7 Multidisciplinary ICU
Transfemoral cerebral angio available 24/7 Inpatient rehabilitation (in-house)
Transoesophageal echo Outpatient rehabilitation available
Monitoring Automated ECG monitoring at bedside Collaboration with outside rehabilitation centre
Automated monitoring of pulsoximetry Treatment, procedures Intravenous rt-PA protocols available 24/7
Automated monitoring of blood pressure and protocols Stroke care map for admission of patients
Automated monitoring of breathing Community stroke-awareness programme
Monitoring of temperature Prevention programme
Invasive treatments provided Intravenous rt-PA protocols available 24/7 Stroke pathways
Carotid surgery
Angioplasty and stenting CEA = carotid endarterectomy; CT = computed tomography; MRI = magnetic resonance
Intra-arterial thrombolysis available 24/7
imaging; ECG = electrocardiogram; rt-PA = recombinant tissue plasminogen activator;
ICU = intensive care unit.
Respiratory support
Surgery for aneurysms
Hemicraniectomy
countries of the 1,466 hospitals that answered the questionnaire and
Ventricular drainage
said that they treat acute stroke patients. These 25 countries were all
Surgery for haematoma
members of the EU, with the exception of Malta and Cyprus, which
Infrastructures Emergency department (in-house)
Collaboration with outside rehabilitation centre
were replaced by Switzerland and Norway. These 886 hospitals treat
Stroke outpatient clinic
about one-third of stroke patients in the above-mentioned countries.
Multidisciplinary ICU
The data refer to the year 2005.
Impatient rehabilitation (in-house)
Outpatient rehabilitation available
One and a half to two hospitals per million inhabitants were randomly
Anticoagulation clinic
selected by a professional specialising in this type of investigation. In
Protocols and procedures Stroke faculty
order to meet the criteria for CSCs, the hospital needed to have at least
Intravenous rt-PA protocols
80% of the components rated as absolutely necessary by at least 50%
Stroke pathways
Clinical research
of the experts and the 20 components rated as absolutely necessary by
Stroke care map for patient admission
more than 75% of the experts (see Table 1). To be rated as a PSC, the
Stroke database hospitals had to have at least 80% of the components rated as
Community stroke awareness programme
absolutely necessary by at least 50% of the experts (see Table 2). More
Prevention programme
than 60% of the contacted hospitals responded, corresponding to
Research grants
52.5% of those hospitals admitting acute stroke patients. On average,
Drug research
each of these hospitals had treated 376 stroke patients in 2005. Only
Stroke clinical fellowship
Stroke study co-ordinator
4.9% of the hospitals met the above criteria for a CSC, and 3.6% for a
Stroke research unit
PSC. Around 40% of the hospitals met the criteria of any hospital
treating stroke patients (see Table 3), but 51.4% did not provide even
EUROPEAN NEUROLOGICAL DISEASE 2007 25
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