Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec;3(4):361-368.
doi: 10.1177/2396987318787695. Epub 2018 Jul 11.

The Dutch Acute Stroke Audit: Benchmarking acute stroke care in the Netherlands

Laurien S Kuhrij  1   2 , Michel Wjm Wouters  2 , Renske M van den Berg-Vos  3 , Frank-Erik de Leeuw  4 , Paul J Nederkoorn  1
Affiliations

The Dutch Acute Stroke Audit: Benchmarking acute stroke care in the Netherlands

Laurien S Kuhrij et al. Eur Stroke J. 2018 Dec.

Abstract

Introduction: In the nationwide Dutch Acute Stroke Audit (DASA), consecutive patients with acute ischaemic stroke (AIS) and intracranial haemorrhage (ICH) are prospectively registered. Acute stroke care is a rapidly evolving field in which intravenous thrombolysis (IVT) and intra-arterial thrombectomy (IAT) play a crucial role in increasing odds of favourable outcome. The DASA can be used to assess the variation in care between hospitals and develop 'best practice' in acute stroke care. Patients and methods: We describe the initiation and design of the DASA as well as the results from 2015 and 2016.

Results: In 2015 and 2016, 55,854 patients with AIS and 7727 patients with ICH were registered in the DASA. Treatment with IVT was administered to 10,637 patients (with an increase of 1.3% in 2016) and 1740 patients underwent IAT (with an increase of 1% in 2016). Median door-to-needle time for IVT and median door-to-groin time for IAT have decreased from 27 to 25 min and 66 to 64 min, respectively. Mortality during admission was 4.9% in patients with AIS, whereas 26% of patients with ICH died. Modified Rankin Scale score at three months was registered in 49% of AIS patients and 45% of ICH patients.

Discussion: During the nationwide DASA, time to treatment is reduced for IVT as well as IAT. With the rapidly evolving treatment of acute stroke care, the DASA can be used to monitor the quality provided on patient- and hospital level.

Conclusion: Increasing completeness of registration of the outcome, in combination with adjustment for patient-related factors, is necessary to define and further improve the quality of the acute stroke care.

Keywords: Stroke; clinical audit; quality indicators.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Distribution of DTNT in patients with AIS treated with IVT for each year. The vertical lines represent the annual median.
Figure 2.
Figure 2.
(a) Boxplots of DTNT with range of distribution from fifth to 95th percentile for 2015 and 2016 combined for each hospital registering in the DASA and (b) difference in median DTNT in minutes (i.e. delta) between 2015 and 2016 for each hospital registering in the DASA. The dotted line reflects the nationwide trend of reduction of median DTNT. DTNT: door-to-needle time.
Figure 3.
Figure 3.
Annual distribution of DTGT in patients with AIS treated with IAT. The vertical lines represent the annual median.
See this image and copyright information in PMC

References

    1. GBD 2016 Cause of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the global burden of disease study 2016. Lancet 2017; 390: 1151–1210. - PMC - PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49: e46–e110. - PubMed
    1. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014; 384: 1929–1935. - PMC - PubMed
    1. Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016; 316: 1279–1289. - PubMed
    1. Nederlandse Vereniging voor Neurologie. Richtlijn herseninfarct en hersenbloeding, https://www.zorginzicht.nl/bibliotheek/acute-beroertezorg/Kwaliteitsstan... (2017, accessed 3 May 2018).

LinkOut - more resources