Stroke Care in Europe

1
Stroke Care in Europe

• L. Garcia-Castrillo, MD, SEMES
• Department of Emergency Medicine
• University Hospital Marques de Valdecilla
• Cantabria, Spain

2
Stroke Chain of recovery
Pepe PE. Ensuring the chain of recovery for
stroke in your community. Acad Emerg Med
19985(4)352-8
3
Teaching Points to be Addressed

• Stroke care in Europe
• The role of Emergency Medicine in Stroke care

4
Setting
L. Garcia-Castrillo
5
Europa

• 45 Languages
• 43 Countries
• 727. Mill. 400 Mill. in EU
• 15 gt65 years

6
Stroke in Europe

• 3rd Cause of death
• 1 million of new cases, with 400.000 casualties
  per year
• First cause of disability
• Accounts 3-5 of total health cost
• Great differences in cost and results

7
Cerebrovascular Disease Females
per 100,000
         
lt
41.64
         
lt
62.64
         
lt
83.64
         
lt
104.6
         
lt
125.6
         
³
125.6
Adjusted Death rate
8
Cerebrovascular Disease Males
per 100,000
         
lt
58.33
         
lt
86.33
         
lt
114.3
         
lt
142.3
         
lt
170.3
         
³
170.3
Adjusted Death rate
9
Stroke Incidence in Europe
Charles D.A. Variations in Stroke Incidence and
Survival in 3 Areas of Europe. Stroke312074-2079
.
10
Relevant Contributions

• WHO Task Force on Stroke and other
  Cerebrovascular Disorders, 1989
• European Federation of Neurological Societies
  Task Force, 1997
• European Ad Hoc Consensus Group, 1996
• Pan European Consensus Meeting on Stroke
  Management, 1995
• EUSI European Federation of Neurological
  Societies (EFNS), European Neurological Society
  (ENS) and European Stroke Council (ESC). 2000

11
Recommendations Emergency Area

• Education
• Stroke symptoms
• EMS use
• Identify Stroke as an emergency medical problem
• Use protocols to identify stroke symptoms in the
  Dispatch Center
• Reduce delays in the prehospital phase
• Transport to a Hospital with an adequate Stroke
  Unit
• ED
• Rapid evaluation
• Treat Medical Problems

12
Results
L. Garcia-Castrillo
13
Variations in Outcomes
Chales DA Wolfe. BIOMED Study of Stroke Care
Group. Stroke 199930350-356.
L. Garcia-Castrillo
14
European Stroke Care Inventory

• 30 EFNS member countries collect information on
  acute stroke care
• 22 countries were represented
• Information represents national data

M. Brainin. Acute neurological stroke care in
Europe Results of the European Stroke Care
Inventory Eu J Neurol 200075-10
15
Stroke Management in Europe I
16
Stroke Management in Europe II
17
Time to Care
L. Serrano Latency time and thrombolitic
treatment of ischemic ictus. Emergencias 1998
10236-238
18
Stroke Emergency Care
IST Collaborative Group. Variations Between
Countries in Outcome After Stroke in
International Stroke Trial (IST) Stroke
2001321370-77
19
Pre-hospital Stroke Care

• European Emergency Data Project

T.Krafft EED Group Comparing European EMS Systems
GEOMED geomed_at_uni-bonn.de
20
L. Garcia-Castrillo
21
EMS Stroke Care Two Systems Comparison
P lt0.05
EED Project
22
Integrated Network Stroke Care

• Period 1998-2000
• Cases 2313
• Arrive with ALS unit doctor 27
• At hospital lt 3h 57
• CT lt 30 min 54
• Thrombolysis 4.1
• 3 months mortality 12.9

Austrian
Steiner MM. The quality of acute stroke units on
nation-wide level the Austrian Stroke Registry
for acute stroke units. Eur J Neurol 20034353-60
23
Teaching Points to be Addressed

• Stroke care in Europe
• There are important geographical differences
  between areas in incidence, process of care and
  outcomes
• Different outcomes can be explained, in part, due
  to the level of resources available

24
Teaching Points to be Addressed

• The role of Emergency Medicine in Stroke care
• EMS is a fundamental part of Stroke care
  facilitating access, high level pre-hospital
  care and integration with in hospital systems
• EMS-ED must be part of the concept of Integral
  Stroke care

25
Summary

• The role of Emergency Medicine in the
  pre-hospital and in the ED is clearly defined in
  guidelines and consensus documents
• More high quality research is needed to clarify
  the best model of care

26
Questions?