XVII. European Stroke Conference
Nice, France

Oral Session:

Regional stroke aspects
Date: Friday 16 May 2008  
Time: 9:30 - 9:40 -  Room: Calliope
Chair: W. Mess, The Netherlands and J.E. Rinkel, The Netherlands

01
Patient Age and Key indicators of Stroke Care: The Irish National Audit of Stroke Care (INASC)
N.F.Horgan    A. Hickey    H. McGee    S. Murphy    D. O'Neill                                   
On behalf of the INASC Team

Royal College of Surgeons in Ireland

IRELAND

The Irish National Audit of Stroke Care conducted a national audit of hospital and community stroke services in the Republic of Ireland 2006-2007. We report on the effect of patient age on the 12 Sentinel key indicators of care. 36 public hospitals providing acute services to stroke patients participated. Data from consecutive discharges for a six-month period in 2005 with a primary diagnosis of stroke using ICD-10-AM were extracted for each of the hospitals for the chart review, which was based on the Clinical Audit Proforma of the UK National Sentinel Stroke Audit 2006. The Irish audit reported lower coverage on all 12 key indicators than both the 2004 and 2006 Sentinel audits. Particularly notable was the virtual absence of stroke unit care in Ireland (2%) while over half (62%) were treated in such units by 2006 in the UK. While initiation of appropriate medication, technological assessment, physiotherapy and patient body weight assessment was conducted for over 40% of Irish patients, services requiring other members of a multidisciplinary team (swallow, occupational therapy needs, mood assessment and multidisciplinary discharge goals for rehabilitation) were available to only about one in four Irish stroke patients. Home assessment was also a service for a minority in Ireland (7%) and the majority (>60%) in the UK. Older stroke patients (>65 years) in Irish hospitals had better access to swallow screening at 24 hours (?2=9.14, p<0.05), OT assessment at 7 days (?2=27.59, p<0.0001) and physiotherapy assessment within 72 hours (?2=13.71, p<0.008) in contrast to those under 65 years. However, older patients were less likely to have a brain scan within 24 hours of their stroke (?2=46.05, p<0.001). Performance across a broad range of indicators of quality of stroke care was much poorer in Ireland compared to the UK. The findings point to the need for an urgent review of stroke services in Ireland to provide appropriate and equitable care for Irish people of all ages with stroke.

Regional stroke aspects
Date: Friday 16 May 2008  
Time: 9:40 - 9:50 -  Room: Calliope
Chair: W. Mess, The Netherlands and J.E. Rinkel, The Netherlands

02
Giving Advice to Passengers Flying after a Stroke - what is the consensus ?
D.R.Collins    K. Given    D. O'Neill                                                 
 

Stroke-Service /Age-Related Health Care Adelaide & Meath Hospital, Dublin.

IRELAND

Introduction: Doctors involved in stroke care are often asked to advise about flying after stroke. Little published evidence or guidelines to reference. We assessed the frequency with which this issue arises, the nature and basis for the advice given. Method:Questionnaire sent to Irish geriatricians and neurologists. e-survey invitation to members of British Association of Stroke Physicians. Results: 105 replies from consultants who manage stroke patients. 51% replies geriatricians, 20% neurology, 29% general /stroke physicians. 18% respondents asked for advice weekly, 42% monthly and 37% quarterly or less (3% never). After a stroke 8% recommended no flying within a week, 22.4 % within a month, 55.1% 2-3 months and 12.2 % recommended no flying for 6 months. 86% and 79% stated this advice would not differ for infarcts or haemorrhages; 44.7 % would allow flying sooner after a TIA. 34% respondents would differentiate between short and long haul flights.53.3% respondents base their advice on experience / colleagues, 13.3% on literature and driving regulations as proxy respectively. Only 6.7 % quoted airline sources for advice. 70% routinely give additional advice to patients flying after ischaemic stroke; advice included prophylactic LMWH (8.9%) increased dose of antiplatelet (6.7%), maintaining hydration (86.7%), alcohol avoidance (66.7%), anti-thrombotic stockings (42.2%), exercising limbs ( 73.3%). 31.1 % respondents give non-medical advice to patients about compliance with airline regulations/travel insurance.Only 13% respondents were aware of a patient actually suffering a stroke and 6.7% having a complication post-stroke while flying. 46.7 % aware of patients having difficulty getting travel insurance after a stroke. Conclusion: Survey shows this is a common request for advice. Most recommend no flying for 1-3 months and mainly base advice on experience /colleagues. 70% give additional medical advice when flying and many respondents aware of travel insurance difficulties for patients after a stroke. There is need for consensus guidelines.

Regional stroke aspects
Date: Friday 16 May 2008  
Time: 9:50 - 10:00 -  Room: Calliope
Chair: W. Mess, The Netherlands and J.E. Rinkel, The Netherlands

03
East Saxony Stroke Network (SOS-NET): Establishing Tele-Stroke Care on the basis of the DIN EN ISO 9001:2000 Quality Management System
G. Gahn    T. Goldhagen    U. Becker    T. Dreischer    S. Schiller    B. Hantsch    M. Eulitz    M. Eberlein-Gonska    D.M.Albrecht       
 

Department of Neurology, University of Technology Dresden, Germany

GERMANY

Background: East Saxony is a rural area with the capital Dresden hosting two stroke units. Stroke patients outside Dresden are usually treated in general hospitals without stroke expertise. We developed a model consisting of a competence center for stroke (Dresden University Stroke Center – DUSC) cooperating with several satellite hospitals in acute stroke care (East-Saxony-Stroke Network - SOS-NET). We considered the quality management (QM-)system DIN EN ISO 9001:2000 as the basis for cooperation. Methods: The stroke unit and the intensive care unit of the neurology department of the university hospital Dresden were certified according to DIN EN ISO 9001:2000 as DUSC. We support the cooperating hospitals to take over our QM-system to establish an equal standard of stroke care in the SOS-NET comparable to secondary stroke centers. The standard of stroke care is controlled by appropriate QM-audits. Acute stroke therapy is guided through a video conference providing the stroke physician at DUSC with real time videos of the acute stroke patient in the local hospital as well as with neuroimaging data, mainly CT images. All patients become part of a data base and are followed 3, 6, 9, and 12 months for outcome evaluation. Primary outcome parameters are recurrent stroke or death and disabling stroke. SOS-NET is supported by the Saxonian Ministery of Health. Results: In June 2007, DUSC was certified according to the requirements of the German Stroke Association and the DIN EN ISO 9001:2000. In July 2007 the first two local hospitals were certified by DUSC as cooperating tele-stroke units. On average, so far about 10 patients are presented each month for acute stroke treatment via video conference. 8/35 patients with acute ischemic stroke has been treated with i.v. t-PA without hemorrhagic complications. Another eight hospitals will join SOS-NET in 2008. Conclusion: Acute stroke therapy in rural areas appears to be possible on the level of secondary stroke centers if technical tools like video conference systems and a transparent QM system are combined.