Important factors in predicting mortality outcome from stroke: Findings from the Anglia Stroke Clinical Network Evaluation Study
| Autor: | David A. Turner, Max O Bachmann, John F. Potter, Rachel Hale, Gill M Price, Yoon K. Loke, Diana J. Day, Anthony K. Metcalf, Stanley D. Musgrave, Elizabeth A. Warburton, Phyo K. Myint |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
services Aging medicine.medical_specialty Pediatrics Time Factors Nursing staff Population Nursing Service Hospital Personnel Staffing and Scheduling MEDLINE Patient characteristics Workload Nursing Staff Hospital Stroke mortality Haemorrhagic stroke older people 03 medical and health sciences 0302 clinical medicine Risk Factors Humans Medicine Prospective Studies 030212 general & internal medicine education Prospective cohort study Stroke Aged Aged 80 and over education.field_of_study business.industry General Medicine Middle Aged Prognosis medicine.disease stroke mortality England staffing Emergency medicine outcome Female Geriatrics and Gerontology business Delivery of Health Care 030217 neurology & neurosurgery Research Paper |
| Zdroj: | Age and Ageing |
| Popis: | Background although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short- and medium-term mortality. Methods data from a prospective multicentre study (2009–12) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient-related factors and service characteristics on stroke mortality outcome at 7, 30 and 365 days post stroke, and time to death within 1 year. Results a total of 2,388 acute stroke patients (mean (standard deviation) 76.9 (12.7) years; 47.3% men, 87% ischaemic stroke) were included in the study. Among patients characteristics examined increasing age, haemorrhagic stroke, total anterior circulation stroke type, higher prestroke frailty, history of hypertension and ischaemic heart disease and admission hyperglycaemia predicted 1-year mortality. Additional inclusion of stroke service characteristics controlling for patient and service level characteristics showed varying prognostic impact of service characteristics on stroke mortality over the disease course during first year after stroke at different time points. The most consistent finding was the benefit of higher nursing levels; an increase in one trained nurses per 10 beds was associated with reductions in 30-day mortality of 11–28% (P < 0.0001) and in 1-year mortality of 8–12% (P < 0.001). Conclusions there appears to be consistent and robust evidence of direct clinical benefit on mortality up to 1 year after acute stroke of higher numbers of trained nursing staff over and above that of other recognised mortality risk factors. |
| Databáze: | OpenAIRE |
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