Considerable regional differences exist in the treatment of patients with acute cerebral infarction. This is the finding presented by Erwin Stolz and his co-authors in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108: 607-611).
The prognosis for patients with stroke largely depends on a rapid, standardized first response. Across the German federal state of Hesse, there are great differences in the time interval between symptom onset and admission to hospital or transfer to a specialist stroke unit. Percentages of patients who receive treatment with drugs that break down the blood clot (thrombolysis) also vary greatly, more than was expected. The average thrombolysis rate in patients admitted to hospital within 3 hours after the stroke was 19%, but rates varied regionally between 6% and 35%.
The authors base their study on data from the mandatory quality assurance program for stroke in Hesse. They argue that improvement is needed; in particular, they believe that treatment paths and care structures within individual hospitals must be analyzed more closely.
Because of its political sensitivity, this report is accompanied by an editorial by Klaus Berger, in which he ascribes the apparently obvious regional differences to a multitude of influencing factors.
Deutsches Ärzteblatt International