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Updating on Italian Stroke Units: the “CCM study”

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Abstract

The Stroke Units (SUs) have been demonstrated to be efficient and cost effective for acute stroke care. Nevertheless, the level of stroke unit implementation in Italy does not correspond to expectations yet. This study is a survey, which aims at assessing the current status of in-hospital stroke care in the Italian regions and at updating SUs. The survey was conducted by means of a semi-structured questionnaire, based on 18 stroke care “quality indicators”, submitted to all the Italian centres that had taken part in the SITS-MOST study, and to other centres advised by the coordinator of SITS studies and by regional opinion leaders of stroke. SUs were defined as acute wards, with stroke-dedicated beds and dedicated teams that had been formally authorised to administer rt-PA. A statistical analysis was performed by a descriptive statistics and logistic regression model. The study was carried out from November 2009 to September 2010. A total of 168 forms were sent out and 153 replies received. Seven centres, which had not performed any thrombolytic treatment, and 16 which did not fulfil the criteria for the definition of SU were excluded from the study. Most of the centres reported more than 100 stroke patient admissions per year, i.e., 122 (84 %) from 100 to 500, 18 (12 %) more than 500. The 19 % of the centres admitted more than 30 % of patients within 3 h from the symptom onset and only 30 % admitted more than 30 % of patients within 4.5 h. The mean number of thrombolyses performed in the last 6 months was 10 for centres with a doctor on duty 24 h a day, 6 for those that have a doctor on duty from 8 a.m. to 8 p.m. and a doctor on call for night, and 5 for centres with a doctor on call 24 h a day. The territorial distribution of the SUs is remarkably heterogeneous: 87 SUs (67 %) are located in the North of Italy, 28 (22 %) in the central part of Italy and only 15 (11 %) in the South. The last few years have witnessed a rise in both the diffusion of SUs and access to thrombolytic therapy in Italy. Despite this, there are a few large areas, mostly in the south, where the requirements of healthcare legislation are not met, and access to a dedicated SU and thrombolytic treatment is still limited and poor.

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Authors and Affiliations

  1. Department of Neurology, G. da Saliceto Hospital, Via Cantone del Cristo, 29100, Piacenza, Italy

    D. Guidetti, M. Spallazzi, E. Rota, N. Morelli & P. Immovilli

  2. Emergency Department Stroke Unit-Sapienza, University of Rome, Rome, Italy

    D. Toni

  3. Center Disease Control, Health Ministry, Rome, Italy

    B. M. Polizzi

  4. Agenzia Sanitaria Emilia Romagna, Bologna, Italy

    S. Ferro

  5. Department of Neurosciences and Pharmacology, University of Florence, Florence, Italy

    D. Inzitari

  6. Institute of Neurosciences, Italian National Research Council, Florence, Italy

    M. Baldereschi

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  1. D. Guidetti
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  2. M. Spallazzi
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  3. D. Toni
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  4. E. Rota
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  5. N. Morelli
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  6. P. Immovilli
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  7. M. Baldereschi
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  8. B. M. Polizzi
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  9. S. Ferro
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  10. D. Inzitari
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Consortia

for the Promotion and Implementation of Stroke Care in Italy Project Working Group

Corresponding author

Correspondence to D. Guidetti.

Appendix

Appendix

Promotion and implementation of stroke care in Italy Project Working Group

Coordinators: D. Inzitari (Dept. Neurosciences and Pharmacology, University of Florence, Italy); B. Maria Polizzi (Center Disease Control, Health Ministry, Rome, Italy). Participants (in alphabetic order): M. Baldereschi (Inst. Neurosciences, Italian-National-Research-Council, Florence, Italy); D. Consoli (Dept. Neurology, Jazzolino Hospital, Vibo Valentia, Italy); L. Candelise (Professor of Neurology, Milan, Italy); A. Di Carlo (Inst. Neurosciences, Italian-National-Research-Council, Florence, Italy); C. Fieschi (Professor of Neurology, Sapienza University of Rome, Italy); D. Guidetti (Dept. Neurology, G. da Saliceto Hospital, Piacenza, Italy); L. Provinciali (Neurological Clinic, Dept. Experimental and Clinical Medicine, Marche Polytechnic, University of Ancona, Italy); M. Rasura (S. Andrea Hospital Stroke Unit, Faculty of Medicine and Psycology, Sapienza University of Rome, Italy); M. Luisa Sacchetti (Dept. Of Neurology and Psychiatry, Sapienza University of Rome, Italy); M. Silvestrini (Neurological Clinic, Dept. Experimental and Clinical Medicine, Marche Polytechnic, University of Ancona, Italy); D. Toni (Emergency Department Stroke Unit, Sapienza University of Rome, Italy).

The centres participating to the study

Abruzzo: A.Carolei H. S. Salvatore, L’ Aquila; U. Calogero H. Renzetti of Lanciano; A. Mancini H. S. Spirito Pescara; M. Assetta H. Mazzini, Teramo; Calabria: D. Consoli H. Iazzolino Cosenza; Campania: M. Feleppa H. G. Rummo, Benevento; M. Quarantiello H. S. Sebastino, Caserta; F. De Falco H. Loreto Nuovo, Napoli; R. Napoletano H. S. Giovanni di Dio e Ruggi; Salerno; Emilia-Romagna: P. Nichelli Nuovo Ospedale civile, Modena; M. R. Tola Arcispedale S. Anna, Ferrara; N. Marcello Arcispedale S. Maria Nuova, Reggio Emilia; G. Procaccianti H. Maggiore, Bologna; F. Cirignotta and R. D’ Alessandro H. S. Orsola, Bologna; U. Scoditti H. Maggiore, Parma, E. Montanari H. di Vaio, Fidenza; A. M. Mauro H. Bufalini, Cesena; W. Neri H. Civile, Forlì; P. Cenni H. Civile, Imola; G. Greco H. Ramazzini, Carpi; A. Ravasio H. degli Infermi, Rimini; G. Ciucci H. Civile, Ravenna; Friuli Venezia Giulia: R. Eleopra H. Universuty Udine; F. Chiodo Grandi H. Riuniti, Trieste; Lazio: M. Concetta Altavista H. S. Filippo Neri, Roma; V. Di Lazzaro H. Gemelli, Roma; M. Rasura H. S. Andrea, Roma; P. Stanzone H. Policlinico Tor Vergata, Roma, C. Pozzessere San Camillo-Forlanini, Roma, D. Toni Policlinico Umberto I°, Roma; G. Salvatori H. Viterbo, Liguria: M. E. Furlan H. Imperia; T. Tassinari H. S. Corona Pietra Ligure, M. Balestrino Universuty, Genova; C. Serrati H. S. Martino; Genova; N.R. Pizio H. Chiavari-Lavagna; P. Profumo H. Savona; M. Del Sette H. S. Andrea, La Spezia, Lombardia: M. Camerlingo H. S. Marco, Zingonia, M. Magoni H. Civili, Brescia; E. Donati H. Fondazione Poliambulanza, Brescia; G. Barutti, H. Voghera; G. Torgano H. Maggiore Policlinico, Milano; P. Bassi H. S. Carlo, Milano; G. Comi H. S. Raffaele, Milano; V. Silani IRCCS Auxologico, Milan; C. S. Taddeo H. S. Rita, Milano; Micieli H. Humanitas; Rozzano; M. Poloni H. Bergamo; C. Ferrarese H. S. Gerardo; Monza; A. Cavallini H. Mondino; Pavia; A. Martignoni H. S. Matteo; Pavia; P. Previdi H. Poma; Mantova; Piemonte: C. Rivetti H. G. B. Bosco, Torino; C. Buffa H. M. Vittoria Torino; C. Labate H. Mauriziano, Torino; P. Cerrato H. Le Molinette, Torino; D. Leotta H. Martini, Torino; R. Sciolla H. S. Luigi, Orbassano; C. Doriguzzi H. E. Agnelli, Pinerolo; F. Passantino H. S. Biagio Domodossola; G. Asteggiano H. S. Lazzaro, Alba; M. De Mattei H. S. Croce, Moncalieri; G. Gusmaroli H. degli Infermi; Biella; F. Monaco H. Maggiore della Carità, Novara; P. Provera H. S. S. Antonio e Margherita, Tortona; D. Seliak H. Savignano; S. Cattaneo H. Novi Ligure; Puglia: F. Federico H. Consorziale, Bari; B. Passerella H. Perrino, Brindisi; L. Specchio H. Riuniti, Foggia; L. Barbarini H. U. Pazzi, Lecce; S. Internò H. SS Annunziata, Taranto; M. Sardegna: Melis H. Brotzu, Cagliari; A. Manca H. S. S. Annunziata, Sassari; Sicilia: A. Mattaliano H. Civile, Palermo; E. Costanzo H. Cannizzaro, Catania; S. Cottone, A. Gasparro H. Villa Sofia, Palermo; F. Iemolo H. R. Guizzardi, Vittoria; R. Musolino H. Riuniti, Messina; M. Stornello H. Siracusa; L. Giglia H. Caltanisetta; Toscana: G. Orlandi H. Riuniti S. Chiara, Pisa; D. Inzitari H Careggi, Firenze; G. Bandinelli H. S. Maria Nuova, Firenze; A. Rossetti H. S. Maria Annunziata, Firenze; S. Spolveri H. S. Giovanni di Dio, Firenze, R. Tassi H. University, Siena; A. Cuccuini H. S. M. alla Gruccia, Arezzo; A. Vinattieri H. Prato; C. Paradiso H. della Misericordia, Grosseto; A. Napolitano H. Campo Marte, Lucca; S. Bartolini H. del Ceppo, Pistoia; G. Panigada H. Pescia; G. Meucci H. Livorno; Umbria: G. Agnelli H. S. M. della Misericordia, Perugia; E. Moschini H. Città di Castello; S. Ricci H. Città di Castello and H. Branca-Gubbio; E. Righetti H. Città della Pieve, M. Zampolini H. Foligno; Valle d’ Aosta: E. Bottacchi H. Aosta; Veneto: F. Perini H. Civile, Vicenza; B. Tavolato H. S. Antonio, Padova; G. Meneghetti H. University, Padova; G. Pistolato H. Umberto I°, Mestre; G. Moretto H. Borgo Trento, Verona; B. Giometto H. Treviso; M. Gentile H. S. Martono, Belluno; S. Bruno H. Conegliano; M. Silvestri H. Legnano; S. Tamburin H. Negrar; M. Morra H. Arzignano; A. Polo H. Monselice; G. Maccarone H. Castelfranco; F. Devetag H. Feltre; R. L’ Erario H. Rovigo; S. D’ Anna H. Portogruaro.

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Guidetti, D., Spallazzi, M., Toni, D. et al. Updating on Italian Stroke Units: the “CCM study”. Neurol Sci 34, 1087–1092 (2013). https://doi.org/10.1007/s10072-012-1226-3

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  • DOI: https://doi.org/10.1007/s10072-012-1226-3

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