OBJECTIVE
To evaluate the effectiveness of the existing registration system and propose an epidemiological model for statistical accounting of the frequency of development of in-hospital ischemic stroke (IHS) in medical organizations of the Russian Federation on the example of St. Petersburg.
MATERIAL AND METHODS
The design of the study, conducted in the period 2014—2021, included two stages. At the first (retrospective) stage (from 01.09.14 to 31.03.16) an initiative analysis of the quality of care for 243 patients (5 medical institutions) was carried out in order to determine the relevance of the issues of IHS for the healthcare of St. Petersburg. At the second (prospective) stage, based on the data of the city stroke registry and sample control of reported cases of IHS during initiative visits and as part of annual audits, an epidemiological analysis of the frequency of occurrence of IHS in city hospitals (11 medical institutions) was performed. At the second stage, 1253 reported cases of IHS were studied: 805 (64.2%) in hospitals providing endovascular care for stroke and 448 (35.8%) in primary stroke centers (PSC). The second stage included 2 chronologically consecutive periods (from 04.01.16 to 31.12.18 and from 01.01.19 to 31.12.21) with testing of 3 different methodological approaches to accounting for the IHS.
RESULTS
The share of IHS in the structure of all ischemic strokes (IS) in hospitals with PSC and regional vascular centers (RVC) in St. Petersburg in the period 2016—2021 was 1.4—2.0%. There were no significant differences in the ratio of IHS in the overall structure of IS between typical hospitals with PSC and RVC. In the general structure of IS, initially diagnosed in hospitals, the proportion of IHS is about 1/3 (~30%), the remaining 2/3 (~70%) of cases are cases of late diagnosis of out-of-hospital vascular events (in various periods), other causes of acute cerebral pathology, cases of illegally established in-hospital vascular events.
CONCLUSION
The proposed calculation model is able to bring closer to understanding the real number of IHS in a large metropolis, but does not reflect its exact number, because is based on accounting for the work of only a part of the city hospitals included in the city’s program of care for patients with stroke.
