Patterns of stroke between university hospitals and non-university hospitals in mainland China: a prospective multicenter hospital-based registry study.

Patterns of stroke between university hospitals and non-university hospitals in mainland China: a prospective multicenter hospital-based registry study.

World Neurosurg. 2016 Nov 9;:

Authors: Wang D, Liu J, Liu M, Lu C, Brainin M, Zhang J

Abstract
BACKGROUND AND OBJECTIVE: In China, stroke has risen to the first commonest cause of death. Currently published data on stroke mainly come from university hospitals, and less from community hospitals, especially lacking information on stroke focusing on the differences between university hospitals and non-university hospitals. Therefore, we aimed to investigate the patterns and the differences of acute stroke between university hospitals and non-university hospitals in China.
METHODS: The survey was conducted in 281 hospitals in China: 62 in the west, 85 in the middle and 134 in the eastern regions. The participating hospitals were sorted into university hospitals (n=93) and non-university hospitals (n=118). We prospectively registered patients with acute stroke within 7 days of symptom onset between April 1 and May 20 of 2006.The diagnosis of stroke was defined by WHO criteria and the pathological types of stroke were determined by clinical and CT/MRI findings. The demographic data, pathological types of stroke, outcomes (death or dependency) at discharge (or 30 days if not discharged) were collected. Dependency was defined as Modified Rankin Score > 2. Basic characteristics, pathological types of stroke and functional outcomes were compared between university hospitals and non-university hospitals.
RESULTS: We enrolled 5273 patients (3135 males; mean age, 65±12years) from the 281 participating hospitals in China, of which ischemic stroke accounted for 70.8% (3733), intracranial hemorrhage for 25.7% (1357) and subarachnoid hemorrhage for 3.5% (183). 3555 patients (67.4%) were from non-university hospitals (n=118), and 1718 patients (32.6%) came from university hospitals (n=93). There were no significant differences between university hospitals and non-university hospitals in terms of age, sex, pathological types of stroke, and history of stroke (all p>0.05). Patients from non-university hospitals had significantly less stroke severity (mRS) on admission (3.1±1.4 Vs 3.2±1.3; p=0.005) than those from university hospitals. After adjustment for age, sex, and mRS on admission, patients with intracranial hemorrhage from non-university hospitals had significantly lower proportion of disability (40.8% Vs 47.1%; p=0.005) and death/disability (49.9% Vs 57.1%; p=0.008) at discharge than those from university hospitals, while there were no significant differences on disability or death/disability of patients with ischemic stroke or subarachnoid hemorrhage between non-university hospitals and university hospitals.
CONCLUSION: This survey comparing stroke patients treated in university and non-university hospitals in China showed that both cohorts were largely comparable including most demographic features, such as age and gender, history of stroke and stroke subtypes. It may be concluded that patient cohorts treated on stroke units in university as well as non-university hospitals are quite similar and stroke units in both types of institutions are also comparable in terms of work load and most patient outcomes.

PMID: 27838433 [PubMed - as supplied by publisher]

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