Efficacy of the stroke networks. Methodology of evaluation. The experience in Burgundy

Abstract

Introduction: Stroke is a frequent and severe disease in France (first cause of handicap, second cause of cognitive decline, third cause of mortality), despite major therapeutical and organizational progress, explaining its role in hospital and inter-hospital networks. Care networks dedicated to stroke allow to the patient an optimal management from home to stroke units. National recommendations recall the implementation of a dedicated network, with an unique call (call 15 in France), moving to Emergency care, then to cerebral imaging and then stroke unit. The aim of this review is to report the evaluation, of the stroke networks implemented in Burgundy since 2003, the responses provided to the needs of the population and the administration, and their translation in other health regions. Methods: By the way of the unique population-based stroke registry that ascertain all the strokes observed into the population of the city of Dijon with a prospective, specific and exhaustive way, we have evaluated the impact of the phone follow-up by nurses on the rates of recurrence and re-hospitalization, the impact of stroke units on mortality rates, the efficacy and safety of tele-fibrinolysis, the impact of primary prevention on the incidence rates, the impact of social and economic deprivation, the efficacy and safety of tele-fibrinolysis and the evolution of the number of strokes for the following years. Results: It was demonstrated that the phone follow-up by nurses was able to decrease the rates of recurrence and re-hospitalization, stroke units were able to decrease the mortality rates during week-ends, tele-fibrinolysis was as efficacious and safety as fibrinolysis in stroke units, primary prevention increased the hope of life without any stroke, incidence and mortality rates were higher in low-incomes population and the number of stroke will increase by 1.4 for the 10 next years. Conclusion: The implementation of stroke networks has an human and logistic cost that needs to be measured, but their efficacy, on prevention and acute care, is certain. Methods developed in Burgundy may be translated in other regions that must develop stroke networks.