Background Depression after stroke is common but often undertreated as increasing depression prevalence and decreasing health care contacts diverge after the event. Objective To develop an acute-phase prediction scale for prognosis of depression 6 months after stroke. Methods Participants (N = 226) were consecutively recruited and assessed within the first week after ischemic stroke for history of depression, stroke severity (National Institutes of Health Stroke Scale), and functional independence (Barthel Index). Early depressive symptoms were self-reported via the Patient Health Questionnaire-2 and external-rated by nurses via the Signs of Depression Scale. Six months later, 183 participants were assessed for Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnosis of depression. Significant predictors of depression were identified in multivariate logistic regression analysis and their coefficients transformed into a risk scale. Measurement precision was identified using receiver operating characteristic curve analysis. Results Depression was diagnosed in 32 (17.5%) participants 6 months after stroke. History of depression, the Barthel Index, and the Patient Health Questionnaire-2 were significant predictors of depression. Transformation of the coefficients yielded the Post-Stroke Depression Risk Scale that demonstrated good discrimination (area under the receiver operating characteristic curve = 0.84; 95% confidence interval = 0.78/0.90). The optimum cutoff showed a sensitivity of 0.81, a specificity of 0.72, a positive predictive value of 0.38, and a negative predictive value of 0.95. Conclusions The Post-Stroke Depression Risk Scale accurately identifies people in the acute phase with low risk of depression 6 months later, which saves expendable psychiatric interviews in stroke patients. While the sensitivity indicates that recognition of people with later depression is adequate, positive results in the acute phase show low predictivity. Clinical and methodological reasons for these results as well as implications for future research to increase case-finding ability are discussed.

The Post-Stroke Depression Risk Scale (PoStDeRiS): Development of an Acute-Phase Prediction Model for Depression 6 Months After Stroke.

Die Leitlinien der Deutschen Gesellschaft fur Neurologie zur Diagnostik und Akuttherapie des ischamischen Schlaganfalls beinhalten die Empfehlung einer Behandlung auf einer Stroke-Unit (SU) sowie die Durchfuhrung rekanalisierender Therapien (intravenose Thrombolyse [IVT] und mechanische Thrombektomie [MT]) bei geeigneten Patienten. Eine flachendeckende Versorgung stellt eine grose organisatorische und gesundheitspolitische Herausforderung dar. Anhand einer regionalisierten Auswertung erfolgte eine aktualisierte Analyse der bundesweiten Versorgungsrealitat. Basierend auf dem Wohnort der Patienten wurden die Versorgungsdaten anhand der DRG-Statistik fur das Berichtsjahr 2018 ausgewertet und mit den Vorjahren verglichen. Es wurden die Raten an SU-Behandlung, IVT und MT in den 412 Kreisen und kreisfreien Stadten Deutschlands analysiert. Es erfolgte eine Typologisierung der Regionen nach ihrem Urbanisierungsgrad. Bundesweit wurden 2018 in 1382 Krankenhausern insgesamt 224.647 Patientenfalle mit der Hauptdiagnose akuter Hirninfarkt behandelt. Es zeigten sich insgesamt vergleichsweise hohe Behandlungsraten (SU = 73,3 %; IVT = 16,4 %; MT = 6,5 %). Lediglich 10,2 % der SU-Behandlungen erfolgten in einer Klinik ohne Neurologie am Standort. Die regionalisierte Analyse ergab einen hohen Streuungsbereich mit signifikant niedrigeren Behandlungsraten in Regionen mit geringerem Urbanisierungsgrad (SU-, IVT-, MT-Raten: stadtisch = 75,4 %; 17,4 %; 7,5 %; landlich = 67,1 %; 15,4 %, 5,3 %). Die Versorgungssituation des akuten Hirninfarkts in Deutschland ist insgesamt als vergleichsweise sehr gut zu bezeichnen. Fur landliche Regionen lasst sich weiteres Optimierungspotenzial dokumentieren.

Bundesweite Versorgungsrealität von Patienten mit akutem Hirninfarkt in Deutschland

Background The guidelines of the German Society for Neurology regarding the diagnostics and treatment of acute ischemic stroke contain the general recommendation of treatment on a stroke unit (SU) and the use of recanalizing treatment (intravenous thrombolysis, IVT; mechanical thrombectomy, MT) in appropriate patients. The nationwide availability of all three components represents a large organizational and healthcare political challenge. Objective Updated nationwide analysis of treatment rates in Germany based on a regionalized evaluation. Methods Based on the patient's place of residence, nationwide data of all hospitalized patients were evaluated using the German diagnosis-related groups (DRG) statistics from 2018 and compared with previous years. The rates for SU treatment, IVT and MT in the 412 German regional districts were analyzed. The 412 regions were grouped according to the degree of urbanization. Results Nationwide, a total of 224,647 patient cases with a main diagnosis of acute ischemic stroke were treated in 1382 hospitals in Germany in 2018. Overall, relatively high treatment rates were determined (SU = 73.3%; IVT = 16.4%; MT = 6.5%). Only 10.2% of treatments in the SU were performed on a SU located at a hospital with no neurology department. The regionalized analysis showed large treatment ranges for all three therapeutic components, with significantly lower treatment rates in regions with a lower degree of urbanization (SU, IVT, MT rates: urban = 75.4%, 17.4%, 7.5% and rural = 67.1%; 15.4%, 5.3%, respectively). Conclusion Hospitalized healthcare in Germany shows high treatment rates for both SU admission and acute recanalization treatment in patients with acute ischemic stroke; however, there is further optimization potential in rural regions.

[Nationwide treatment reality of patients with acute ischemic stroke in Germany : Update of the regionalized analysis on use of recanalization treatment procedures and stroke complex treatment].

Objective: Transient global amnesia (TGA) is defined by an acute memory disturbance of unclear etiology for a period of <24 h. Several studies showed differences in vascular risk factors between TGA compared to transient ischemic attack (TIA) or healthy controls with varying results. This retrospective and cross-sectional study compares the cardiovascular risk profile of TGA patients with that of acute stroke patients. Methods: Cardiovascular risk profile and MR imaging of 277 TGA patients was retrospectively analyzed and compared to 216 acute ischemic stroke patients (26% TIA). Results: TGA patients were significantly younger and predominantly female compared to stroke patients. A total of 90.6% of TGA patients underwent MRI, and 53% of those showed hippocampal diffusion-weighted imaging (DWI) lesions. Scores for cerebral microangiopathy were lower in TGA patients compared to stroke patients. After statistical correction for age, TGA patients had higher systolic and diastolic blood pressure, higher cholesterol levels, lower HbA1c, as well as blood glucose levels, and lower CHA2DS2-VASc scores. Stroke patients initially displayed higher CRP levels than TIA and TGA patients. TGA patients without DWI lesions were older and showed higher CHA2DS2-VASc scores compared to TGA patients with DWI lesions. Conclusion: This study revealed significant differences between TGA and stroke patients in regard to the cardiovascular risk profile. Our main findings show a strong association between acute hypertensive peaks and TGA in patients not adapted to chronic hypertension, indicating a vascular cause of the disease.

/pdf/transient-global-amnesia-tga-influence-of-acute-hypertension-3c8nyceoda.pdf

Transient Global Amnesia (TGA): Influence of Acute Hypertension in Patients Not Adapted to Chronic Hypertension.

In der Arbeit wird ein Uberblick uber mogliche Methoden zur Erfassung von Behandlungsrealitaten akuter Schlaganfallpatient*innen in Akutkrankenhausern gegeben. Unter Berucksichtigung spezifischer Vor- und Nachteile der unterschiedlichen Moglichkeiten erfolgt der gezielte Abgleich der Bezugsfalle aus einer strukturierten Analyse der deutschlandweiten DRG-Statistik und der Daten der Geschaftsstelle Qualitatssicherung Hessen zur Schlaganfallakutbehandlung (SA_HE) fur das Jahr 2018. Nach DRG-Statistik bzw. SA_HE wurden 2018 in Hessen 16.267 bzw. 15.643 akute ischamische Schlaganfallpatient*innen behandelt (ICD I63), davon waren 53,7 % bzw. 54,5 % Manner. Die Altersverteilung in ihrer Gesamtheit zeigte keinen signifikanten Unterschied, allerdings waren die >70-jahrigen Schlaganfallpatient*innen in der DRG-Statistik signifikant haufiger vertreten. Die Rate an systemischen Thrombolysen betrug nach beiden Datenquellen 16,5 %, die an mechanischer Thrombektomie 5,6 % bzw. 5,9 %. Die Analyse zeigt, dass nach einer rationalen Eingrenzung der einbezogenen Falle sowohl Fallzahlen, Geschlechter- und Altersverteilung wie auch die erfassten Raten an systemischer Thrombolyse und mechanischer Thrombektomie bei Bezug auf den Behandlungsort eine ausreichend hohe Ubereinstimmung ohne statistische Unterschiede aufweisen. Hieraus kann geschlossen werden, dass das untersuchte, gut kontrollierte Qualitatssicherungsregister eine ausreichend hohe Fallzahl an Schlaganfallpatient*innen mit erfolgten Akuttherapien erfasst. Es erscheint somit empfehlenswert, dass die strengen Vorgaben der Datenerhebung und -kontrolle bundesweit ubernommen werden. Hierdurch ware eine deutschlandweite kombinierte Analyse der Daten der Arbeitsgemeinschaft Deutschsprachiger Schlaganfall-Register (ADSR) und der DRG-Statistik moglich.

Comparability of different data sources on stroke care in Germany

In der Arbeit wird die aktuelle Qualitat der akutstationaren Versorgung von Schlaganfallpatienten in Deutschland im Jahre 2018 anhand standardisierter und evidenzbasierter Qualitatsindikatoren dargestellt. Hierzu werden die Berichte der regionalen Qualitatssicherungsprojekte zum Krankheitsbild Schlaganfall ausgewertet, die im Rahmen der Arbeitsgemeinschaft Deutschsprachiger Schlaganfall-Register (ADSR) zusammenarbeiten. Insgesamt wurden im Jahre 2018 in den berucksichtigen Qualitatssicherungsprojekten uber 280.000 Behandlungsverlaufe dokumentiert. Die Ergebnisse der 16 definierten Qualitatsindikatoren, die die Behandlungsphasen Diagnostik, Akuttherapie, Rehabilitation sowie Sekundarpravention umfassen, zeigen insgesamt ein sehr hohes Niveau der akutstationaren Behandlung des Schlaganfalls in Deutschland. Lediglich einzelne Qualitatsindikatoren, wie z. B. „fruhzeitige Verlegung zur Thrombektomie“, weisen auf grosere Erfordernisse fur eine Prozessoptimierung hin.

Quality of care of acute ischemic stroke in Germany 2018

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Quality of care of acute ischemic stroke in Germany 2018