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Research paper
Variations in acute stroke care and the impact of organised care on survival from a European perspective: the European Registers of Stroke (EROS) investigators
  1. Salma Ahmed Ayis1,2,
  2. Bolaji Coker1,2,
  3. Ajay Bhalla1,
  4. Ian Wellwood1,2,
  5. Anthony G Rudd1,2,
  6. Antonio Di Carlo3,4,
  7. Yannick Bejot5,
  8. Danuta Ryglewicz6,
  9. Daiva Rastenyte7,
  10. Peter Langhorne8,
  11. Martin S Dennis9,
  12. Christopher McKevitt1,2,
  13. Charles D A Wolfe1,2
  1. 1Division of Health and Social Care Research, King's College London, London, UK
  2. 2NIHR Biomedical Research Centre Guy's and St Thomas’ NHS Foundation Trust and King's College London, London, UK
  3. 3Institute of Neurosciences, Italian National Research Council, Florence, Italy
  4. 4Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
  5. 5Department of Neurology, University of Burgundy, University Hospital of Dijon, Dijon, France
  6. 61st Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
  7. 7Institute of Cardiology, c/o Kaunas University of Medicine, Kaunas, Lithuania
  8. 8Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, Scotland, UK
  9. 9Division of Clinical Neurosciences, Western General Hospital, Edinburgh, Scotland, UK
  1. Correspondence to Dr Salma Ahmed Ayis, Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, 5th floor, Capital House, 42 Weston Street, London SE1 3QD, UK; salma.ayis{at}


Background The need for stroke care is escalating with an ageing population, yet methods to estimate the delivery of effective care across countries are not standardised or robust. Associations between quality and intensity of care and stroke outcomes are often assumed but have not been clearly demonstrated.

Objective To examine variations in acute care processes across six European populations and investigate associations between the delivery of care and survival.

Methods Data were obtained from population-based stroke registers of six centres in France, Lithuania, UK, Spain, Poland and Italy between 2004 and 2006 with follow-up for 1 year. Variations in the delivery of care (stroke unit, multidisciplinary team and acute drug treatments) were analysed adjusting for case mix and sociodemographic factors using logistic regression methods. Unadjusted and adjusted survival probabilities were estimated and stratified by levels of Organised Care Index.

Results Of 1918 patients with a first-ever stroke registered, 30.7% spent more than 50% of their hospital stay in a stroke unit (13.9–65.4%) among centres with a stroke unit available. The percentage of patients assessed by a stroke physician varied between 7.1% and 96.6%. There were significant variations after adjustment for confounders, in the organisation of care across populations. Significantly higher probabilities of survival (p<0.01) were associated with increased organisational care.

Conclusions This European study demonstrated associations between delivery of care and stroke outcomes. The implementation of evidence-based interventions is suboptimal and understanding better ways to implement these interventions in different healthcare settings should be a priority for health systems.

  • Evidence-Based Neurology
  • Cerebrovascular Disease
  • Health Policy & Practice
  • Stroke

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