How attaining the goals of a stroke care pathway is related to functional outcome after stroke. A nationwide study

Abstract

AbstractBackground and purposeIn 2018 a stroke care pathway (SCP) was introduced in Norway. The goal of the pathway was to improve acute stroke care by reducing time-delay. We aimed to evaluate if achieving the target times of the SCP was associated with a better functional outcome at 3 months post-stroke and to identify characteristics of patients attaining the goals.MethodsWe performed a register-based study with data from the Norwegian stroke register (NSR). Patients registered with acute stroke in 2019 were included. Functional outcome at 3 months in the patients with “achievement” was compared to patients with “non-achievement”. Achievement was defined as attaining three important goals in the SCP; 1) time from symptom onset to contact with the emergency medical service, 2) time from symptom onset to arrival in hospital, 3) time from arrival in hospital to admission to a stroke unit. Additionally, we evaluated time from arrival in hospital to treatment with intravenous thrombolysis. Modified Rankin Scale (mRS) was used to measure functional outcome at 3 months post-stroke and functional independence was defined as mRS 0-2. Characteristics of the “achievers” were analysed by univariate and multivariate logistic regression analyses.ResultsIn total 2818 patients were included, 460 (16%) were in the achievement group. The mean (SD) age was 72.5 (12.6) years and 1201 (43%) were women. The probability of being independent at 3 months post-stroke was significantly higher in the achievement group versus the non-achievement group (OR 1.36, 95% CI 1.04-1.79, p=0.026). The “achievers” were significantly younger, less likely to be living alone, less likely to have diabetes, more often had an ischemic stroke and were admitted with more severe strokes than the “non-achievers”.ConclusionGoal achievement in the SCP was significantly associated with independence 3 months post-stroke.