| アブストラクト | BACKGROUND: The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. METHODS AND RESULTS: Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. CONCLUSIONS: CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type. |
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| ジャーナル名 | PloS one |
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| Pubmed追加日 | 2014/5/16 |
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| 投稿者 | Iihara, Koji; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Miyamoto, Yoshihiro; Suzuki, Akifumi; Ishikawa, Koichi B; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru |
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| 組織名 | Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu;University, Fukuoka, Japan.;Department of Preventive Medicine and Epidemiologic Informatics, National;Cerebral and Cardiovascular Center, Suita, Japan.;Clinical Research Center, National Hospital Organization, Nagoya Medical Center,;Nagoya, Japan.;Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center,;Suita, Japan.;Department of Neurosurgery, Iwate Medical University, Morioka, Japan.;Chiba Cardiovascular Center, Ichihara, Japan.;Department of Neurosurgery, Kyorin University, Mitaka, Japan.;Showa University Hospital, Tokyo, Japan.;Department of Neurosurgery, Nagoya University, Nagoya, Japan.;Department of Neurosurgery, Nagasaki University, Nagasaki, Japan.;Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular;Center, Suita, Japan.;Department of Preventive Medicine and Community Health, University of;Occupational and Environmental Health, Kita-Kyushu, Japan.;Research Institute for Brain and Blood Vessels, Akita, Japan.;Center for Cancer Control and Information Services, National Cancer Center,;Tokyo, Japan.;Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita,;Japan.;Department of Public Health, The University of Tokyo, Tokyo, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/24828409/ |
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