DOI: https://doi.org/10.25305/unj.137777

Stroke units in the world and Ukraine: requirements, realities and prospects

Eugene G. Pedachenko, Anna N. Nikiforova

Abstract


Objective. To assess the state of neurosurgical care (NSC) provision to stroke patients in Ukraine, to determine the possibilities for integrating stroke units (including neurovascular ones) into a single network.

Materials and methods. The results of the full-design statistical study of the clinical work of neurosurgical units (NSU) of Ukraine in the years 2008 to 2017 were analyzed. Statistical methods of sampling and grouping, time series studies were used. Calculations were performed using Microsoft Office Excel.

Results. Over the last 10 years the number of hospital patients increased by 33 % (from 7,160 in 2008 to 9,520 in 2017), the number of those operated by 76 % (from 2,573 to 4,532). Per a million people the growth rate is even greater: the rate of hospitalization increased by 59 % (from 156 to 248), the rate of surgeries enlarged by 111 % (from 56 to 118).

In the structure of patients operated in NSU, the share of those who underwent surgeries because of stroke increased from 6 % to 11 %.

In 2017 85 NSU provided care to patients with stroke. Among them, 8 units are neurovascular, 7 units may be regarded as those ones by formal signs, the rest are multifaceted NSU.

NSC for stroke is concentrated in the capital and large cities. In 2017, 45 % of surgeries relating to stroke were performed in the NSU of the capital (2,044 surgeries out of 4,532). Another 27 % (1,015) of operated patients received surgical treatment in the units in Dnipropetrovsk, Kharkiv, Vinnytsia, Lviv.

In 2017, in Ukraine the share of operated persons among those to whom such surgery is indicated amounted to 16 %. The maximum rate of NSC provision is in Kyiv (126.3 %). However, it is wrong to analyze it as care provided to residents of Kyiv, because a major part of those operated there were residents of other regions. Among regions, the population of Ivano-Frankivsk (17.9 %), Dnipropetrovsk (16.2 %), Lviv regions (12.1 %) were the most provided with NSC for stroke; in 8 regions the coverage was 5–10 %; in 10 — less than 5 % of the need.

The lack of information on the number of stroke units, their distribution throughout the country, the number of treated stroke patients cause the necessity of creation of a framework of stroke units, their certification and accounting of their activities.

Conclusions. Over the last 10 years in Ukraine the indicators of NSC provision to stroke patients improved. However, the rate of coverage of stroke patients with NSC remains low, with a considerable swing in the rate by regions of Ukraine. The necessity of integrating stroke units (including neurovascular ones) into a single network, their certification and keeping statistical accounting have become urgent.


Keywords


stroke; neurosurgical care; neurosurgical units; stroke unit; stroke care

References


1. Top 10 causes of death [Internet]. Geneva (Switzerland): World Health Organization. 2018 [cited 22 June 2018]. Available at: http://www.who.int/gho/mortality_burden_disease/causes_death/top_10/en/

2. Stroke Europe cause of death [Internet]. World Life Expectancy. 2018 [cited 22 June 2018]. Available from: http://www.worldlifeexpectancy.com/europe/stroke-cause-of-death

3. Troian MY, Kostyuchenko NM. [Organizational and economic measures to reform the health care system in Ukraine on the way to overcome the demographic crisis]. Mechanism of Economic Regulation. 2018;(1):116-126. Russian. Available from: https://essuir.sumdu.edu.ua/bitstream/123456789/41856/1/troian_demographic_crisis.pdf

4. Kjellstrцm T, Norrving B, Shatchkute A. Helsingborg Declaration 2006 on European stroke strategies. Cerebrovasc Dis. 2007;23(2-3):231-41. [CrossRef] [PubMed]

5. Ringelstein EB, Chamorro A, Kaste M, Langhorne P, Leys D, Lyrer P, Thijs V, Thomassen L, Toni D; ESO Stroke Unit Certification Committee. European Stroke Organisation recommendations to establish a stroke unit and stroke center. Stroke. 2013 Mar;44(3):828-40. [CrossRef] [PubMed]

6. Hess DC, Audebert HJ. The history and future of telestroke. Nat Rev Neurol. 2013 Jun;9(6):340-50. Review. [CrossRef] [PubMed]

7. Klein KE, Rasmussen PA, Winners SL, Frontera JA. Teleneurocritical care and telestroke. Crit Care Clin. 2015 Apr;31(2):197-224. [CrossRef] [PubMed]

8. Sharma S, Padma MV, Bhardwaj A, Sharma A, Sawal N, Thakur S. Telestroke in resource-poor developing country model. Neurol India. 2016 Sep-Oct;64(5):934-40. [CrossRef] [PubMed]

9. Bernetti L, Nuzzaco G, Muscia F, Gamboni A, Zedde M, Eusebi P, Zampolini M, Corea F. Stroke networks and telemedicine: An Italian national survey. Neurol Int. 2018 Apr 4;10(1):7599. [CrossRef] [PubMed] [PubMed Central]

10. Lukovits TG, Von Iderstine SL, Brozen R, Pippy M, Goddeau RP, McDermott ML. Interhospital helicopter transport for stroke. Air Med J. 2013 Jan-Feb;32(1):36-9. [CrossRef] [PubMed]

11. Saler M, Switzer JA, Hess DC. Use of telemedicine and helicopter transport to improve stroke care in remote locations. Curr Treat Options Cardiovasc Med. 2011 Jun;13(3):215-24. [CrossRef] [PubMed] [PubMed Central]

12. Faizov AT, Avilova VV. A comparative analysis of foreign experience of anti-stroke service establishing and anti-stroke practice in the Republic of Tatarstan. Upravleniye ustoychivym razvitiyem. 2016;(2):35-40. Russian. Available from: https://elibrary.ru/item.asp?id=26510551&

13. Rajan Suja S, Baraniuk S, Parker S, Wu TC, Bowry R, Grotta JC. Implementing a mobile stroke unit program in the United States: why, how, and how much? JAMA Neurol. 2015 Feb;72(2):229-34. [CrossRef] [PubMed]

14. Bowry R, Parker S, Rajan SS, Yamal JM, Wu TC, Richardson L, Noser E, Persse D, Jackson K, Grotta JC. Benefits of Stroke Treatment Using a Mobile Stroke Unit Compared With Standard Management: The BEST-MSU Study Run-In Phase. Stroke. 2015 Dec;46(12):3370-4. [CrossRef] [PubMed]

15. Nyberg EM, Cox JR, Kowalski RG, Vela-Duarte D, Schimpf B, Jones WJ. Mobile Stroke Unit Reduces Time to Image Acquisition and Reporting. AJNR Am J Neuroradiol. 2018 Jul;39(7):1293-1295. [CrossRef] [PubMed]

16. McPherson KM, McNaughton HK. When is a stroke unit not a stroke unit? Qual Saf Health Care. 2005 Feb;14(1):6. [CrossRef] [PubMed] [PubMed Central]

17. Budincevic H, Tiu C, Bereczki D, Kхrv J, Tsiskaridze A, Niederkorn K, Czlonkowska A, Demarin V; CEESS Working Group. Management of ischemic stroke in Central and Eastern Europe. Int J Stroke. 2015 Oct;10 Suppl A100:125-7. [CrossRef] [PubMed]

18. Arnao V, Popovic N, Caso V. How is stroke care organised in Europe? Presse Med. 2016 Dec;45(12 Pt 2):e399-e408. [CrossRef] [PubMed]

19. Theofanidis D, Fountouki A. An Overview of Stroke Infrastructure, Network, and Nursing Services in Contemporary Greece. J Neurosci Nurs. 2017 Aug;49(4):247-250. [CrossRef] [PubMed]

20. Lee SJ, Park H-K, Park T-H, Lee KB, Bae H-J, Rha J-H, Heo JH, Lee B-C, Chung C-S. Stroke System of Care: A Policy Statement from the Korean Stroke Society. Journal of the Korean Neurological Association. 2015 Aug 1;33(3):226–8. [CrossRef]

21. Ringelstein EB, Kaste M, Hacke W, Leys D. Stroke Care in Europe - The Role of Stroke Units. European Neurological Review. Touch Digital Media, Ltd.; 2007;(2):24. [CrossRef]

22. Ringelstein EB, Meckes-Ferber S, Hacke W, Kaste M, Brainin M, Leys D; European Stroke Initiative executive committe. European Stroke Facilities Survey: the German and Austrian perspective. Cerebrovasc Dis. 2009;27(2):138-45. [CrossRef] [PubMed]

23. Higashida R, Alberts MJ, Alexander DN, Crocco TJ, Demaerschalk BM, Derdeyn CP, Goldstein LB, Jauch EC, Mayer SA, Meltzer NM, Peterson ED, Rosenwasser RH, Saver JL, Schwamm L, Summers D, Wechsler L, Wood JP; American Heart Association Advocacy Coordinating Committee. Interactions within stroke systems of care: a policy statement from the American Heart Association/American Stroke Association. Stroke. 2013 Oct;44(10):2961-84. [CrossRef] [PubMed]

24. Stroke unit care. In: The Burden of Stroke in Europe Report. [Internet]. Stroke Alliance for Europe. 2018 [cited 08 June 2018]. Available from: http://strokeeurope.eu/index/acute-stroke-care/4-1stroke-unit-care/

25. ESO Certification Platform [Internet]. European Stroke Organisation. 2018 [cited 30 June 2018]. Available from: https://www.eso-certification.org/

26. The Top Stroke Certification Offerings. [Internet]. Joint Commission. 2018 [cited 08 June 2018]. Available from: https://www.jointcommission.org/certification/dsc_neuro2.aspx

27. Stroke Certification Availability. [Internet]. Jointcommission.org. 2018 [cited 28 June 2018]. Available from: https://www.jointcommission.org/direct_stroke_certification/

28. Pedachenko E, Nikiforova A, Sapon N, Huk A. [Mortality from cerebrovascular diseases in Ukraine]. Ukrainian Neurosurgical Journal. 2016;(3):39-47. Russain. [CrossRef]

29. Borovyk S.P. Akademiya insul’tu: standartyzatsiya ta perspektyvy nadannya medychnoyi dopomohy. Ukrainian medical journal [Internet]. 2015;(6):14-16. 2018 [cited 28 June 2018]. Ukrainian. Available from: https://www.umj.com.ua/article/91303/

30. Stasenko T. Do 2019 r. — 1500 insul’tnykh likaren’: takoyu ye meta yevropeys’koho proektu “Initsiatyva Angels”, do yakoho nyni pryyednalasya i Ukrayina. Ukrainian medical journal [Internet]. 2016;(6):26-28. 2018 [cited 28 June 2018]. Ukrainian. Available from: https://www.umj.com.ua/article/102854/


GOST Style Citations






Copyright (c) 2018 Eugene G. Pedachenko, Anna N. Nikiforova

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.