Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study

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dc.contributor.authorOuyang, Menglu
dc.contributor.authorZhang, Yao
dc.contributor.authorWang, Xia
dc.contributor.authorSong, Lili
dc.contributor.authorBillot, Laurent
dc.contributor.authorRobinson, Thompson
dc.contributor.authorLavados, Pablo
dc.contributor.authorArima, Hisatomi
dc.contributor.authorHackett, Maree L.
dc.contributor.authorOlavarría, Verónica
dc.contributor.authorMuñoz Venturelli, Paula
dc.contributor.authorMiddleton, Sandy
dc.contributor.authorWatkins, Caroline L.
dc.contributor.authorPontes-Neto, Octavio M.
dc.contributor.authorLee, Tsong-Hai
dc.contributor.authorBrunser, Alejandro
dc.contributor.authorAnderson, Craig S.
dc.date.accessioned2021-08-17T21:55:12Z
dc.date.available2021-08-17T21:55:12Z
dc.date.issued2020
dc.description.abstractObjective: Access to acute stroke unit (ASU) care is known to vary worldwide. We aimed to quantify regional variations in the various components of ASU care. Method: Secondary analysis of the Head Positioning in acute Stroke Trial (HeadPoST), an international, multicentre, cluster crossover trial of head-up versus head-down positioning in 11,093 acute stroke patients at 114 hospitals in 9 countries. Patients characteristics and 11 standard components of processes of care were described according to ASU admission within and across four economically-defined regional groups (Australia/UK, China [includes Taiwan], India/Sri Lanka, and South America [Brazil/Chile/Colombia]). Variations in process of ASU care estimates were obtained in hierarchical mixed models, with adjustment for study design and potential patient- and hospital-level confounders. Results: Of 11,086 patients included in analyses, 59.7% (n = 6620) had an ASU admission. In China, India/Sri Lanka and South America, ASU patients were older, had greater neurological severity and more premorbid conditions than non-ASU patients. ASU patients were more likely to receive reperfusion therapy and multidisciplinary care within regions, but the components of care varied across regions. With Australia/UK as reference, patients in other regions had a lower probability of receiving reperfusion therapy, especially in India/Sri Lanka (adjusted odds ratio [aOR] 0.27, 95% confidence interval [CI] 0.12–0.63) and multidisciplinary care (mainly in formal dysphagia assessment, physiotherapy and occupational therapy). Conclusion: There is significant variation in the components of stroke care across economically-defined regions of the world. Ongoing efforts are required to reduce disparities and optimise health outcomes, especially in resource poor areas.es
dc.identifier.citationJournal of the Neurological Sciences, 2020, vol.419:117187es
dc.identifier.urihttps://doi.org/10.1016/j.jns.2020.117187es
dc.identifier.urihttp://hdl.handle.net/11447/4352
dc.language.isoenes
dc.subjectStroke unitses
dc.subjectCarees
dc.subjectInternationales
dc.subjectClinical triales
dc.subjectOutcomees
dc.subjectAcute strokees
dc.titleQuantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST studyes
dc.typeArticlees

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