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National variations in mortality and functional outcome: should we be worried?
  1. D W J Dippel
  1. Correspondence to:
 Dr Diederik W J Dippel
 Department of Neurology, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, The Netherlands; d.dippel{at}erasmusmc.nl

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International registries should be established to monitor process and outcome of care after stroke

The ultimate goal of our efforts in (pre-)clinical stroke research and patient management is to deliver effective and high quality care at reasonable cost. It follows that we should be able to measure the results of the delivery of stroke care on an aggregate level, and, when variations at the hospital or national level are encountered, we should be able to point out the factors that cause this variation. This is not easily done.

In this issue, Gray et al (see pages 327–33) present an analysis of national variations in mortality and functional outcome after stroke.1 This substudy was based on the data from a large randomised multicentre trial of a low molecular weight heparin, tinzaparin.2 Outcome was defined as death or dependency at 6 months from onset of stroke. The authors point out that one would expect outcomes to be similar throughout the western world, after adjustment for variations …

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