stroke units in the czech republic – current situation
DESCRIPTION
STROKE UNITS IN THE CZECH REPUBLIC – CURRENT SITUATION. MUDr.Daniel Václavík Ostrava Vítkovice Hospital. ISCHEMIC STROKE ( IS ). -Disease incidence amounts to 280 strokes people out of 100 , 000 yearly. -This ranks us among one of the first places in Europe. - PowerPoint PPT PresentationTRANSCRIPT
STROKE UNITS IN THE CZECH REPUBLIC – CURRENT
SITUATIONMUDr.Daniel Václavík
Ostrava Vítkovice
Hospital
ISCHEMIC STROKE ( IS )-Disease incidence amounts to 280 strokes people
out of 100,000 yearly.-This ranks us among one of the first places in
Europe.-Stroke is in CZ the most frequent cause of death
and invalidity.-Death rate among people older than 65 years is
double in CZ compared to other EU states.-CZ pledged at Helsingborg Conference together
with other states to decrease mortality till 2005 under 40%.
System Measures
1/ organization of pre-hospital care
2/ establishing stroke units /SU/ and stroke centers /SC/
3/ establishing specialized outpatients' departments to ensure primary and secondary prevention
Advantages of Specialized Care at an Stroke Unit
-Random studies proved that hospitalization and care at SU reduce mortality and no. of independent patients by up to 30% compared to hospitalizations at a standard department
-decreasing total cost of treatment - shorter hospitalization, smaller number of complications
Required Number of SU Beds
• IS incidence 280/100,000• 28,000 IS in the Czech Rep./year• 4 beds per 100,000 inhabitants are needed
when hospitalizing 70% of strokes, with average SU time of 5 days and utilized 70 %
• Approx. 30% strokes – hospitalization at other departments for severe other disease or impossibility to improve patient´s prognosis (recurrent stroke with Rankin score higher than 4)
Minimum Criteria for an SU
• Delivery time max. 90 minutes• Appliances and technical equipment meeting
Czech criteria for intensive care• Therapy and patient´s care by a neurologist,
available 24/7• CT, lab 24/7• Vessels examination (at least one of:
ultrasound,CTA,MRA), minimum surgery hours Mo – Fr, better 24 hrs every day
• Sufficient numbers of minimum 100,000 with the goal to treat at least 280 ÍS/year
General Medical Measures with STROKE
-monitoring vital functions-pulmonary embolism and deep venous
thrombosis prevention-treatment of cardiac disorders, hyperglycemia,
fever,elecrolyte disturbances-prevention and treatment of bronchopneumonia-pressure sores prevention-from the second day of hospitalization active
rehabilitation, possibly logopedics care-after complex stabilization transfer to a standard
department
Cerebrovascular Team - Minimum
Parts of team are the following :
- neurologists
- radiologists
- internists (kardiologist)
- rehabilitation therapist
- speech therapist
- educated medical staff ( nursing care )
Cerebrovascular Team – Stroke Centre
Parts of team are the following: - neurologists- radiologists- internists, cardiologists- interventional neuroradiologist- neurosurgeon- vascular surgeon- rehabilitation therapist- speech therapist- educated medical staff ( nursing care )- psychologist
Goal
1. Identify no. of stroke units ( SU ) in CZ2. Analyze percentage of SU in neurological departments
and general internal depertements and no of trombolysing units
3. Identify no. of stroke beds in individual regions4. Find out how many thrombolysis are carried out in
individual regions out of potential 4 % of patients suitable for thrombolysis
5. Identify stroke beds effectivity in connection with thrombolysis in individual regions – ration of stroke beds and no. of thrombolysis
6. Comparison of years 2006 and 2007
Methodology
• Data sources• Czech Statistic Office – no. of inhabitants in
regions• Stroke questionnaire – sent to all head
physicians of neurological departments• Study by company Boehringer – questionnaires
at departments• Trombolytic SITS register • List of neurological departments• SU questionnaire of Ministry of Health
Results
Neurological departments
STROKE beds – neurologic + general
Thrombolysing SU June 2006 upper chart, June 2007 down chart
SU thrombolysig more than 10 pat/year June 2006 upper chart, June 2007 down chart
No. in 2006 % 2006
Districts 86 ( 10 Prague) 100
Neurological departements
71 82
SU neurological + general
49 ( 52 in 2007 ) 57
SU neurological 33 38
Thrombolysing SU 26 ( 46 in 2007) 30
SU with 10 and more thrombolysis/year
7 ( 18 in 2007) 8 ( 31 % 2007 )
Region No. of inhabitants
No. Of Stroke beds 06, 07
Required no. No. of thrombolysis
6/05-6/06
11/06-11/07
No of required thrombolysis ( 4 % of all strokes )
Moravsko
slezský
1269467 38 ( 74%)
51 ( 100% )
51 63 ( 44%)
99 ( 69 % )
142
Olomoucký 639369 18 ( 69%)
14 ( 54 % )
26 35 ( 48%)
46 ( 63 % )
72
Zlínský 595010 12 ( 50%)
13 ( 54 % )
24 19 ( 28%)
16 ( 23 %)
67
Jihomoravský
1127718 35 ( 77%)
35 ( 77%)
45 29 ( 23%)
86 ( 69 %)
125
Vysočina 519211 16 ( 76%)
19 ( 90 % )
21 2( 3%)
9( 15%)
58
Pardubický 508281 9 ( 45%)
11 ( 55 % )
20 8 (14%)
8 (14 %)
56
Královehradecký
550724 18 ( 81%)
20 ( 90 % )
22 17 (27%)
27(43 %)
62
Region No. of inhabitants
No. Of Stroke beds 06, 07
Required no. No. of thrombolysis
6/05-6/06
11/06-11/07
No of required thrombolysis ( 4 % of all strokes )
Praha 1165581 49 (106%)
62 (134 % )
46 32 ( 24%)
108(83%)
130
Středo
český
1122473 13 ( 28%)
24 ( 53 % )
45 0
15( 12%)
125
Jiho
český
625267 14 ( 56%)
16 ( 64 % )
25 15 (21%)
22( 31%)
70
Liberecký 428184 14 ( 82%)
17 ( 100 %)
17 13 (27%)
17(36%)
47
Ústecký 820219 29 ( 87%)
18 ( 54 % )
33 14 (15%)
35(38 %)
92
Karlo
varský
304343 4 (33%)
11 ( 91%)
12 4 ( 11%)
5(14 %)
34
Plzeňský 550688 6 (27%)
6 ( 27 % )
22 4 (6%)
35(56 %)
62
Total 275 (67%)
287 ( 70 %)
409 255 (22%)
526(46 %)
1142
Required numbers of stroke beds as per regions, in %, 2006
106
87 82 81 77 76 74 6956 50 45
33 28 27
0
20
40
60
80
100
120
Required numbers of stroke beds as per regions, in %, in 2007
134
54
82 9077
90100
5464
54 55
94
53
27
020406080
100120140160
Thrombolysis percentage 2006
4844
28 27 27 24 23 2115 14 11
6 3 00
10
20
30
40
50
60
Thrombolysis percentage 2007
6369
23
4336
83
69
3138
14 14
56
15 12
0102030405060708090
Beds effectivity coefficient
% thrombolysis / % stroke beds 2006
0,690,59 0,56
0,37 0,33 0,33 0,32 0,31 0,290,22 0,22
0,17
0,04 00
0,10,20,30,40,50,60,70,8
Beds effectivity coefficient
% thrombolysis / % stroke beds 2007
1,16
0,690,42 0,48 0,47
0,150,36 0,25
0,890,61
2,07
0,7
0,16 0,22
0
0,5
1
1,5
2
2,5
Conclusion
• In 2006 at least 33% stroke beds missing (reported data include also beds with patients having other than IS diagnosis)
• 2007 increased the number of stroke beds by 3%
• Generally low percentage of thrombolysed patients , 0.88 % of all IS in 2006 – more than doubled to 1.88 % of all IS in 2007
• In 8% of districts more than 10 throbolysis were done in 2006, in 2007 already 31 % of all SU
Conclusion
• Huge unevenness among no. of stroke beds in individual regions
• Huge unevenness among numbers of thrombolysed patients as well as in stroke units effectivity
• Increase of thrombolysed patients(2.13 times) and functiong stroke units with thrombolysis higher than 10 pacients per year (3.87 times)
THANK YOU FOR YOUR ATTENTION