Introduction: Organized stroke care is an integrated approach to managing stroke to improve outcomes. However, the effectiveness of organized stroke care on mortality and morbidity remains uncertain. This study aimed to examine whether Organized stroke care index (OCI), which graded 0-3 based on the presence of rehabilitation, stroke team assessment, and admission to a stroke unit, developed to assess the accessibility to stroke care by Saposnik (Neurology 2010) influenced stroke outcomes in a nation wide hospital cohort.
Hypothesis: OCI influenced mortality and morbidity of patients with ischemic and hemorrhagic stroke.
Methods: Of the 1369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding comprehensive stroke care capacities. Among the institutions that responded, data on patients hospitalized between April 1, 2010 and March 31, 2014, because of stroke were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality morbidity was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, Charson Score and the number of OCI fulfilled in each component and in total.
Results: Data from 265 institutions and 220,027 emergency-hospitalized patients were analyzed. Patients fulfilled the criteria for admission to a SCU, stroke team assessment and the presence of rehabilitation were 29.9%, 41.2% and 66.5%, respectively. Mortality adjusted for age, sex, Charson score and level of consciousness was significantly correlated with admission to a SCU (OR=0.83, p<0.001), SCU team assessment (OR=0.84,P<0.001), and rehabilitation (OR=0.36, p=0.031). OCI was significantly associated with decreased mortality (OR=0.45, p<0.001) and the highest OCI score was associated with 89.4% decrease of mortality. (OR=0.104, p<0.001) Modified ranking scale 0 to 2 rate were also associated significantly with SCU admission (p<0.001). These association holds for ischemic stroke and subarachnoid hemorrhage.
Conclusion: A strong association between organized stroke care and lower mortality was apparent. These data suggest that organized stroke care should be provided to stroke patients regardless of stroke subtype.