A retrospective analysis of 3124 case histories of patients of different sexes, who were hospitalized according to the indications in an emergency to the stroke unit of KNP "Vinnytsia Regional Clinical Psychoneurological Hospital. acad. OI Yushchenko Vinnytsia Regional Council "(hereinafter Hospital A) and Vinnytsia City Clinical Emergency Hospital (hereinafter Hospital B) for the period 2017-2019 with a diagnosis of acute stroke (AS). The RES-Q report form (version 1.2) was completed on a case-by-case basis - a report form in an international program developed by the ESO-EAST initiative of the European Stroke Society (ESO). This form makes it possible to obtain information about the clinical parameters of a stroke, as well as time indicators of individual procedures that characterize the quality of the medical institution.
For the first time, the structure and prevalence of stroke in men and women of different ages were studied within the hospital registers of both hospitals in Vinnytsia. The instability in the dynamics of epidemiological and clinical indicators, the difference between the obtained results and the official statistics is shown.
The three-year follow-up period showed a stable ratio of ischemic and hemorrhagic types of stroke in hospital A – 7:1, regardless of gender, the ratio in hospital B was 9:1 in men and 13:1 in women. Significant reduction in the share of hemorrhagic stroke in the structure of the GMI of the urban population, makes it possible to argue for a more controlled course of hypertension.
The principles of organization and control of processes in the prehospital period of stroke were studied for the first time. The percentage of patients admitted to hospital A in the first 24 hours was significantly higher (p=0.05) than to hospital B (91.2 %; 81.2 %, respectively). In contrast, the percentage of patients admitted to hospital A at a later period after 24 hours (3.3 %), after 48 hours (2.5 %) was significantly lower (p<0.05), and in hospital B this figure was 6.0 % and 8.9 %. More significant differences in the quality of medical care at the pre-hospital stage are the admission of patients to hospitals within the "therapeutic window" (0-3 hours). In hospital A this figure was 34.5 % of patients, in hospital B – 19.1 %. This indicates a significant difference in the organization and control of processes in the prehospital period. For the first time, thanks to the received data of the register it became possible to estimate qualitative differences of the organization of clinical and diagnostic process in hospitals A and B:
- the percentage of patients who underwent neuroimaging in the first hour of hospitalization (in hospital A 96.5 %; in hospital B – 63.4 %);
- the percentage of use of the NIHSS diagnostic scale (for hospital A – 94.6 %, for hospital B – 77.9 %);
- atrial fibrillation screening in hospital A was performed by 62.8 % of patients with GMI, in hospital B – 16.4 %;
- duplex scanning of the vessels of the neck was performed in hospital A – 70.4 %, in hospital B – 6.8 %.
For the first time in our study, differences in the quality of secondary stroke prevention were identified: there was a higher percentage of patients in hospital B who were prescribed antiplatelet therapy (83.8 %) compared to 67.4 % in hospital A, due to significantly higher prescriptions of debigatran and rivaroxaban. in hospital A.
The main differences in the quality of treatment in stroke departments of hospitals concerned the percentage of patients referred directly to rehabilitation medical institutions (in hospital A – 21.8 %, while in hospital B only 2.7 %, which significantly affects the long-term consequences of AS).
According to the European Stroke Control Plan for 2018-2030 – 15 % of patients should receive thrombolytic therapy and 5 % – mechanical thrombectomy. In Hospital A, this figure averaged 20 % of patients with ischemic stroke over three years of follow-up. The door-to-needle time averaged 25.7 minutes, which is twice the maximum recommended by European standards. In hospital B, no thrombolysis procedure was performed, despite the conditions.
During the three-year follow-up, a consistently high level of quality of care in hospital A was established on the basis of a well-thought-out local protocol and patient routes and a significant increase in indicators in hospital B.
