Stroke Center Care and Outcome: Results from the CSPPC Stroke Program

Abstract

The aim of this study was to assess the association between admission to stroke centers for acute ischemic stroke and complications and mortality during hospitalization in a Chinese population by means of an observational study using data from the China Stroke Center Data-Sharing Platform. We compared in-hospital complications and mortality for patients admitted with acute ischemic stroke (N = 13,236) between November 1, 2018 and December 31, 2018 at stroke center (SH) and non-stroke center (CH) hospitals using distance to hospitals as an instrumental variable to adjust for potential prehospital selection bias. The results showed that complication rates during hospitalization among ischemic stroke patients who received thrombolytic therapy (n = 11,203) were lower in the SH group than in the CH group: 11.1% vs 15.7% (absolute difference, − 5.11% [95% CI, − 6.05 to − 3.99%], odds ratio [OR] 0.85 [95% CI, 0.74 to 0.92]). The incidence of intracranial hemorrhage was reduced from 4.2 to 3.2%: SH group vs CH group, 3.2% vs 4.2% (absolute difference, − 1.24% [95% CI, − 1.65 to − 0.82%], OR 0.83 [95% CI, 0.69 to 0.0.98]). Furthermore, the total mortality rate in the SH group was also lower than in the CH group: SH group vs CH group, 2.2% vs 3.0% (absolute difference, − 0.92% [95% CI, − 1.48 to − 0.53%], OR 0.85 [95% CI, 0.73 to 0.96]). The data showed that admission to SH hospitals was associated with a lower risk of treatment complications and death for patients with an acute ischemic stroke receiving thrombolytic therapy.

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Data Availability

Please contact the correspondence author for the data request.

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Acknowledgements

We thank Hugh McGonigle, from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac), for editing the English text of a draft of the manuscript. We especially want to express our gratitude to those doctors and medical staff who participated in the clinical data collection. We need special thanks Dr. Gang Xu (The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China), Dr. Yang Yang (Hengshui Harrison International Peace Hospital, Hengshui, China) and Mr. Xiao-Dong Niu (China Stroke Data Center, Beijing, China) who had helped us to collect data and perform statistical processing.

Participating Hospitals

Capital Medical University Xuanwu Hospital; Tianjin Huanhu Hospital; Shanghai Changhai Hospital; Chuzhou Central Hospital; Hebei Medical University Second Hospital; General Hospital of the Northern War Zone of the Chinese People’s Liberation Army; Dalian Central Hospital; Shenyang First People’s Hospital; Jilin University First Hospital; Jilin City Center Hospital; Jiangsu Provincial People’s Hospital; Nanjing Gulou Hospital; Nanjing First Hospital; The First Affiliated Hospital of Suzhou University; Second Affiliated Hospital of Zhejiang University School of Medicine; Henan Provincial People’s Hospital; First Affiliated Hospital of Zhengzhou University; West China Hospital of Sichuan University; Liaocheng People’s Hospital, Xi’an Jiaotong University First Affiliated Hospital; Anhui Provincial Hospital; Zhengzhou Central Hospital; Wuhan First Hospital; Zhoukou Central Hospital; Guizhou Medical University Affiliated Hospital; Linyi People’s Hospital; Nanyang Central Hospital; Hubei Provincial Third People’s Hospital; Harbin Medical University Affiliated Second Hospital; Yichang Central People’s Hospital;

Peking University Third Hospital; More hospitals information can be found at https://www.sinosc.org/WebManage/StrokeCenter/StrokeCenter

Funding

This study was supported by grants from National Health and Family Planning Commission of China.

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Authors

Contributions

Wang LD had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Tu WJ, Shen Y, Chao BH, Cao L, and Wang LD contributed to the study concept and design. Tu WJ, Chao BH, and Shen Y contributed to the acquisition of the data. Tu WJ, Chao BH, and Cao L carried out the analysis and interpretation of the data. Tu WJ, Shen Y, Chao BH, and Cao L contributed in the drafting of the manuscript. Wang LD is responsible for the critical revision of the manuscript for important intellectual content. Tu WJ, Shen Y, and Chao BH are responsible for the administrative, technical, or material support. Wang LD obtained the funding. Wang LD supervised.

Corresponding authors

Correspondence to Wen-Jun Tu or Long-De Wang.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

This study was approved by the institutional review board of Capital Medical University Xuanwu Hospital, with waiver for informed consent.

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The funding organizations had no role in the design and concept of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.

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Shen, Y., Chao, BH., Cao, L. et al. Stroke Center Care and Outcome: Results from the CSPPC Stroke Program. Transl. Stroke Res. 11, 377–386 (2020). https://doi.org/10.1007/s12975-019-00727-6

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Keywords

  • Stroke center
  • Mortality
  • Complication
  • In-hospital
  • China