02621nas a2200373   4500000000100000008004100001100001600042700001700058700001300075700001200088700001900100700001200119700001200131700001100143700001400154700001500168700001500183700001100198700001500209700001700224700001100241700001900252700001100271700002400282700001600306700001900322245005700341250001500398300001200413490000800425050001600433520174700449020005102196       2016                            d1 aRobinson T.1 aMiddleton S.1 aArima H.1 aPeng B.1 aAnderson Craig1 aSong L.1 aMead G.1 aCui L.1 aHackett M1 aLavados P.1 aWatkins C.1 aLee T.1 aPandian J.1 aOlavarria V.1 aLim J.1 aPontes-Neto O.1 aLin R.1 aP. Venturelli Munoz1 ade Silva H.1 aBillot Laurent00aRegional variation in acute stroke care organisation  a2016/11/23  a126-1300 v371  a[IF]: 2.4743 a<p>
BACKGROUND: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). METHODS: HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. RESULTS: 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P&lt;0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P=0.002) compared to MIC hospitals. CONCLUSIONS: Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes.
</p>
  a1878-5883 (Electronic)<br/>0022-510X (Linking)