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- Title
Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study.
- Authors
Akiko Kada; Kunihiro Nishimura; Jyoji Nakagawara; Kuniaki Ogasawara; Junichi Ono; Yoshiaki Shiokawa; Toru Aruga; Shigeru Miyachi; Izumi Nagata; Kazunori Toyoda; Shinya Matsuda; Akifumi Suzuki; Hiroharu Kataoka; Fumiaki Nakamura; Satoru Kamitani; Koji Iihara; Kada, Akiko; Nishimura, Kunihiro; Nakagawara, Jyoji; Ogasawara, Kuniaki
- Abstract
<bold>Background: </bold>Although the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances.<bold>Methods: </bold>Of the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education. Consistency and validity were examined using correlation coefficients and factorial analysis.<bold>Results: </bold>The CSC score (median, 14; interquartile range, 11-18) varied according to hospital volume. The five subcategories showed moderate consistency (Cronbach's α = 0.765). A strong correlation existed between types of available personnel and specific expertise. Using the 2011 Japanese Diagnosis Procedure Combination database for patients hospitalized with stroke, four constructs were identified by factorial analysis (neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and neurocritical care and rehabilitation) that affected in-hospital mortality from ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The total CSC score was related to in-hospital mortality from ischemic stroke (odds ratio [OR], 0.973; 95% confidence interval [CI], 0.958-0.989), intracerebral hemorrhage (OR, 0.970; 95% CI, 0.950-0.990), and subarachnoid hemorrhage (OR, 0.951; 95% CI, 0.925-0.977), with varying contributions from the four constructs.<bold>Conclusions: </bold>The CSC score is a valid measure for assessing CSC capabilities, based on the availability of neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and critical care and rehabilitation services.
- Subjects
JAPAN; STROKE; CEREBROVASCULAR disease; NEUROLOGY; NEURORADIOLOGY; SUBARACHNOID hemorrhage; FACTOR analysis; CEREBRAL ischemia; CEREBRAL ischemia treatment; CEREBRAL hemorrhage treatment; STROKE diagnosis; STROKE treatment; CEREBRAL hemorrhage; COMPARATIVE studies; DATABASES; HOSPITALS; RESEARCH methodology; MEDICAL cooperation; RESEARCH; EVALUATION research; HOSPITAL mortality; DIAGNOSIS; THERAPEUTICS
- Publication
BMC Neurology, 2017, Vol 17, p1
- ISSN
1471-2377
- Publication type
journal article
- DOI
10.1186/s12883-017-0815-4