Introduction: Evidences of comprehensive stroke center regarding mortality and hospitalization days are insufficient.
Hypothesis: To examine temporal changes in mortality and hospitalization days in patients with ischemic and hemorrhagic stroke according to stroke subtype and comprehensive stroke care capabilities in a nationwide hospital cohort in Japan.
Methods: We conducted annual nationwide survey from 2011 to 2014 using data from the Japanese Diagnosis Procedure Combination database on patients hospitalized with ischemic and hemorrhagic stroke in a nationwide hospital cohort in Japan (J-ASPECT Study). Comprehensive stroke care capabilities were evaluated by 25-items score (Comprehensive stroke center (CSC) score) developed by this study group based on the institutional survey conducted in 2011, including 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education. The effect of year on stroke mortality and hospitalization days was analyzed by mixed effect model with age, gender, Japan Coma Scale, and CSC score as a fixed effect, and hospital as a random effect.
Results: The total numbers of patients were 252,940 in ischemic stroke (IS), 97,236 in intracerebral hemorrhage (ICH), and 30,521 in subarachnoid hemorrhage (SAH). The mortality in IS decreased from 6.3% to 5.7% over the four years (P < 0.001 for trend), and the effect of year was larger in hospitals with high CSC score (<17) than low CSC score (≧17); adjusted odds ratios (95% confidence interval) per year were 0.92 (0.90 - 0.95) and 0.96 (0.93 - 0.98) respectively. The mortality of patients with ICH and SAH did not show significant change as from 15.1 to 16.9 and 25.9 to 26.2, respectively. The median hospitalization days changed from 19 to 17 in IS, from 28 to 24 in SAH, and from 21 to 22 in ICH.
Conclusion: Over the last four years, mortality in patients with ischemic but not hemorrhagic, stroke significantly decreased, especially in hospitals with higher comprehensive stroke care capabilities in Japan. The hospitalization days decreased in IS and SAH patients through four years.