Guideline compliance improves stroke outcome

G. Micieli, A. Cavallini, G. P. Anzola, L. Frattola, A. Mamoli, S. Quaglini, M. Stefanelli

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Guidelines for medical practice have been proposed in different countries in order to improve stroke patient management reducing costs, but the impact of their application on mortality, disability, and costs has not yet been verified. The aim of the present study was to evaluate the impact of the guidelines (GL) for ischemic stroke proposed by the American Heart Association on mortality and functional disability in first-ever ischemic stroke. Three hundred eighty-six patients, consecutively observed from February 1998 to April 1999 in the four centers participating the study (Stroke Unit, C. Mondino Found., Pavia; Depts. of Neurology, Bergamo, Brescia and Monza), were included. The patients enrolled up to 6 h from stroke onset were included in the acute (AP) and early clinical (ECP) phases of the study, those observed after 6 h in the ECP only. Follow-up lasted 6 months. Primary end-points were mortality and functional disability (Barthel Index: BI). The number of non-compliances (NC) to each task of grade A of the guideline was calculated for each patient. A score of 0 was assigned if the task was done and of 1 if it was not done. A non-compliance score was computed for each patient. Kaplan-Meier method and log-rank test were used to estimate survival curves and the differences between groups, respectively, Cox-regression analysis to identify risk-factors for mortality, T-test for paired data, and Wilcoxon test and Pearson's correlation test to compare BI scores. The case fatality rate for the entire population was 7% at 7 days, 11.9% at 30 days and 16.9% at 6 months. Mortality was directly correlated with the number of noncompliances (P

Original languageEnglish
JournalNeurological Sciences
Issue number4 SUPPL.
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology


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