TY  - JOUR
A1  - Hillmann, Steffi
A1  - Wiedmann, Silke
A1  - Rücker, Viktoria
A1  - Berger, Klaus
A1  - Nabavi, Darius
A1  - Bruder, Ingo
A1  - Koennecke, Hans-Christian
A1  - Seidel, Günter
A1  - Misselwitz, Björn
A1  - Janssen, Alfred
A1  - Burmeister, Christoph
A1  - Matthis, Christine
A1  - Busse, Otto
A1  - Hermanek, Peter
A1  - Heuschmann, Peter Ulrich
T1  - Stroke unit care in Germany: the German stroke registers study group (ADSR)
JF  - BMC Neurology
N2  - Background:
Factors influencing access to stroke unit (SU) care and data on quality of SU care in Germany are scarce. We investigated characteristics of patients directly admitted to a SU as well as patient-related and structural factors influencing adherence to predefined indicators of quality of acute stroke care across hospitals providing SU care.

Methods:
Data were derived from the German Stroke Registers Study Group (ADSR), a voluntary network of 9 regional registers for monitoring quality of acute stroke care in Germany. Multivariable logistic regression analyses were performed to investigate characteristics influencing direct admission to SU. Generalized Linear Mixed Models (GLMM) were used to estimate the influence of structural hospital characteristics (percentage of patients admitted to SU, year of SU-certification, and number of stroke and TIA patients treated per year) on adherence to predefined quality indicators.

Results:
In 2012 180,887 patients were treated in 255 hospitals providing certified SU care participating within the ADSR were included in the analysis; of those 82.4% were directly admitted to a SU. Ischemic stroke patients without disturbances of consciousness (p < .0001), an interval onset to admission time ≤3 h (p < .0001), and weekend admission (p < .0001) were more likely to be directly admitted to a SU. A higher proportion of quality indicators within predefined target ranges were achieved in hospitals with a higher proportion of SU admission (p = 0.0002). Quality of stroke care could be maintained even if certification was several years ago.

Conclusions:
Differences in demographical and clinical characteristics regarding the probability of SU admission were observed. The influence of structural characteristics on adherence to evidence-based quality indicators was low.
KW  - stroke register
KW  - stroke unit care
KW  - quality of health care
KW  - quality indicators
Y1  - 2017
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159447
VL  - 17
IS  - 49
ER  - 
TY  - JOUR
A1  - Kraft, Peter
A1  - Fleischer, Anna
A1  - Wiedmann, Silke
A1  - Rücker, Viktoria
A1  - Mackenrodt, Daniel
A1  - Morbach, Caroline
A1  - Malzahn, Uwe
A1  - Kleinschnitz, Christoph
A1  - Störk, Stefan
A1  - Heuschmann, Peter U.
T1  - Feasibility and diagnostic accuracy of point-of-care handheld echocardiography in acute ischemic stroke patients - a pilot study
JF  - BMC Neurology
N2  - Background:
Standard echocardiography (SE) is an essential part of the routine diagnostic work-up after ischemic stroke (IS) and also serves for research purposes. However, access to SE is often limited. We aimed to assess feasibility and accuracy of point-of-care (POC) echocardiography in a stroke unit (SU) setting.

Methods:
IS patients were recruited on the SU of the University Hospital Würzburg, Germany. Two SU team members were trained in POC echocardiography for a three-month period to assess a set of predefined cardiac parameters including left ventricular ejection fraction (LVEF). Diagnostic agreement was assessed by comparing POC with SE executed by an expert sonographer, and intraclass correlation coefficient (ICC) or kappa (κ) with 95% confidence intervals (95% CI) were calculated.

Results:
In the 78 patients receiving both POC and SE agreement for cardiac parameters was good, with ICC varying from 0.82 (95% CI 0.71–0.89) to 0.93 (95% CI 0.87–0.96), and κ from 0.39 (−95% CI 0.14–0.92) to 0.79 (95% CI 0.67–0.91). Detection of systolic dysfunction with POC echocardiography compared to SE was very good, with an area under the curve of 0.99 (0.96–1.00). Interrater agreement for LVEF measured by POC echocardiography was good with κ 0.63 (95% CI 0.40–0.85).

Conclusions:
POC echocardiography in a SU setting is feasible enabling reliable quantification of LVEF and preliminary assessment of selected cardiac parameters that might be used for research purposes. Its potential clinical utility in triaging stroke patients who should undergo or do not necessarily require SE needs to be investigated in larger prospective diagnostic studies.
KW  - ischemic stroke
KW  - systolic dysfunction
KW  - point-of-care echocardiography
KW  - ejection fraction
KW  - stroke unit
KW  - feasibility
KW  - accuracy
Y1  - 2017
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158081
VL  - 17
IS  - 159
ER  -