Acute neurological stroke care in Europe: results of the European Stroke Care Inventory

Following the 1997 Recommendations of the EFNS Task Force on Acute Neurolog ical Stroke Care (European Journal of Neurology, 1997: 4:435-441) a Europea n Inventory was undertaken to assess the development of acute stroke care i n the EFNS member countries and to give an estimate of the needs based on 1 997 data. All 30 members of the EFNS Stroke Scientist Panel were asked to complete a questionnaire on acute stroke epidemiology as well as acute stroke care in their country. Data were based either on national surveys, hospital statist ics, or estimates given on the basis of extrapolation of regional studies, or other defined sources. Specialist estimates were also taken into account where no other data source was available. Data from 22 countries were received and referred to almost one million str okes occurring per year in a population of over 500 million. Most epidemiol ogical data confirmed an east-west gap known from previous studies. These i ncluded rates that, in eastern countries, were higher for incidence, stroke as a leading cause of death, and 30-day case-fatality; and rates that were lower for overall hospitalization or availability of CT scanning. East-wes t differences were not seen for the total number of acute stroke units or t he number of acute stroke units set up within neurological hospital departm ents, nor for most other quality indicators of acute stroke care with the e xception of technological standards in some countries. The higher rates for 30-day case-fatality in eastern Europe (mostly above 2 0%) compared with western Europe (mostly below 20%) are probably caused by a case mix with more severe ischemic strokes and a higher percentage of cer ebral haemorrhages admitted for acute care in eastern Europe. This is proba bly due to the higher prevalence of the most common risk factors for stroke in these countries which tend to result in more severe strokes. This, ther efore, underlines the need for stroke prevention programmes especially in e astern Europe. This epidemiological east-west gap is not reflected by most quality indicators for acute stroke care, e.g. total number of acute stroke units available within each country. Most eastern European countries have a well-developed neurological care system for acute stroke but still have u rgent technological and socioeconomical needs. The leading role of clinical neurology in acute stroke care is visible in most but not all European cou ntries.