[Evaluation of the public-health intervention "Healthy Lower Rhine...against Stroke" by means of clinic data in the district of Wesel, Germany. Comparative study with clinic data samples in 2003 and in 2005].

Abstract

Background and purpose: The initiative "Healthy Lower Rhine ... against Stroke" aims at improving stroke knowledge in the community, i.e., knowledge of stroke symptoms and proper action when stroke signs occur (call emergency number 112) in order to reduce prehospital times/delay. An expert group in the district of Wesel decided to raise an inventory of stroke-care quality in the whole district. Samples of patient data were drawn in all hospitals in the district of Wesel, in order to gain a database for evaluation of possible effects on prehospital time due to the intervention.

Material and methods: All hospitals in the Wesel district collected data from patients presenting with stroke signs. Data collection was performed for a time span of 3 months before (T0 in 2003) and during (T1 in 2005) the public-health intervention. Standardized data collection was performed with a short version of the questionnaire issued by the German Stroke Registers Study Group (ADSR). Influential factors on prehospital time and means of transportation were analyzed by multivariate logistic regression.

Results: The portion of patients hospitalized within a <3-h window after onset of stroke symptoms did no vary between 2003 and 2005 (27.3% vs. 27.5%). In 2005, acute care of stroke patients was performed more frequently in the emergency department (33% in 2003 vs. 84% in 2005). Before the start of the stroke intervention, seven clinics collected data on 326 patients, and in 2005, 375 patients were registered by all eight hospitals in the district of Wesel. Mean age of patients rose from 72 to 74 years. The portion of men dropped from 50% to 43%.

Conclusion and perspective: Obviously, prehospital delay was not reduced after a 2-year run of a stroke campaign. It is recommended to carry out a second survey into community stroke knowledge in the district of Wesel. If a significant trend of improved knowledge should be detected, a new evaluation through clinic data sampling would make sense.