RESUMEN
BACKGROUND: Echocardiography is highly relevant in patients with ischemic stroke or TIA. Utilization of routine echocardiographic examinations [transthoracic (TTE) or transesophageal (TEE)] on stroke units remains however unknown. To representatively examine echocardiographic rates on stroke units in Germany and to evaluate structural factors that may influence the decision to conduct echocardiography. METHODS: A nationwide analysis was performed by using certification audit data of all primary and comprehensive stroke centers (pSC and cSC) in Germany. RESULTS: Structural and organizational requirements of 310 departments (cSCs: 42.6%) were extracted. Median TTE rate was 63.3% (IQR 39.3-80.8), median TEE rate 21.3% (IQR 16.4-29.5). A cardiological department on site was present in 74.2%, and they were associated with higher TEE rates. TTE rates decreased with increasing numbers of patients (p = 0.026). Likewise, TEE rates decreased with increasing numbers of patients (p = 0.006), mediated by departments with cSCs (p = 0.008 for cSCs vs p = 0.230 for pSCs). TTE rates were far more inhomogeneously distributed than TEE rates and higher in pSCs (p = 0.011). Overall, 12.9% of centers did not perform any echocardiographic examination in at least 50% of all stroke patients. CONCLUSION: More detailed recommendations regarding echocardiography should be included in future guidelines. Moreover, evaluating the impact of echocardiographic examinations on long-term prognosis in stroke patients should be focus of further evaluations.
RESUMEN
This article describes the revised criteria for certified stroke units (SU) in Germany that will apply from 1 October 2018. Due to the high level of quality only minor adjustments and specifications were necessary in many places and the majority of criteria remained unchanged. For the first time a uniform personnel quota of ≥1.75 full-time staff per monitor bed is defined, which is a better reflection of the treatment reality. The evidence-based process of acute vascular imaging using computed tomography angiography (CTA) and alternatively magnetic resonance angiography (MRA) is now defined as a minimum rate of≥20â¯% of all brain infarcts. In this way the timely identification of suitable candidates for endovascular thrombectomy (ET) should be accomplished. Ultrasound diagnostics of arteries supplying the brain remain an integral part of additional diagnostics after cerebral ischemia because this generates supplementary information. The extended detection of atrial fibrillation is newly included as a diagnostic minimum standard and necessitates measures that go beyond a single long-term electrocardiograph (ECG). In order to facilitate the certification of telemedically supplied SU (Tele-SU), the minimum standard of stroke patients was reduced to ≥200 per year. A Tele-SU in the immediate catchment area of a certified SU (<20â¯km) must provide proof of a regional treatment need in order for certification to be approved. Quality criteria in the audit reports have now a greater importance. They require a concrete plan of action, which must be tracked within the framework of the interim report and must be presented for the recertification. Furthermore, the SU are called upon not to limit the endeavors for quality only to the minimum requirements.