Variation in in-patient stroke management in ten centres in different countries: The INCLEN multicentre stroke collaboration

Background and purpose: Large within-country variations have been described in stroke management and there have been a few studies of between-country variation (in the USA and the UK). We designed a study to examine stroke ma nagement across a wide range of countries representing different stages of economic development. Large variations would suggest the need to explore me thods of increasing the uptake of evidence-based stroke practice. Methods. Members of the International Clinical Epidemiology Network (INCLEN) from 14 centres in ten countries agreed to review the records of the last 50 patie nts admitted to hospital with a clinical diagnosis of stroke. Information o n demographic variables, the clinical diagnosis of stroke type, investigati ons performed and treatments given and the discharge destination of the pat ient were recorded and sent to the coordinating centre in Australia for ana lysis. Results: There were statistically significant between-centre differe nces in the proportions of patients cared for by a neurologist, staying in hospital for at least ten days and having CT or MRI scans. Significant betw een-centre differences were also seen for treatment, for example, the use o f aspirin in non-haemorrhagic stroke varied from 11 to 79%. The variation ( for all interventions studied) was no longer statistically significant when examined within strata according to availability of facilities. Conclusion s: The large variation between centres in the management of stroke is large ly 'explained' by the availability of resources, even for interventions tha t do not depend on resource availability. It will be important to develop m anagement guidelines that reflect evidence-based practice of relevance acro ss a range of economic settings. (C) 1999 Elsevier Science B.V. All rights reserved.