22. European Stroke Conference 346 Management and economics Golden hours and acute hospitalization cost to repair one-point NIHSS impairment F. Boutot1, K. Milojevic2, S. Parisse3, C. Dubois-Richard4, B. Marcaillou5, A. Laboucheix6, O. Richard7, Y. Lambert8 SAMU 78, Versailles Hospital, Le Chesnay, FRANCE1, SAMU 78, Versailles Hospital, Le Chesnay, FRANCE2, SAMU 78, Versailles Hospital, Le Chesnay, 3, SAMU 78, Versailles Hospital, Le Chesnay, FRANCE4, SAMU 78, Versailles Hospital, Le Chesnay, FRANCE5, Emergency De-partment, Versailles Hospital, Le Chesnay, FRANCE6, SAMU 78, Versailles Hospital, Le Chesnay, FRANCE7, SAMU 78, Versailles Hospital, Le Chesnay, FRANCE8 Background : Stroke generates important socioeconomic burdens and heavy hospital expenses. The objective of this report was to evaluate early stage hospital cost for stroke patients transported by Mobile Intensive Care Units (MICU),to estimate the cost of acute health care necessary to repair one-point NIHSS impairment and to investigate the impact of MICU delay on the price of one-point NIHSS treatment. Methods : 395 patients with NIHSS score notified during pre-hospital management (year 2004 to 2012) were separated into 3 groups: “short” = MICU arrival within 45 min of symptom onset, “me-dium” = 45 min to 2 hours, “long” = MICU arrival beyond 2 hours. In order to obtain similar profile regarding age, gender, stroke mechanism (ischemic or hemorrhagic), NIHSS score and comorbidity, reports were submitted to matching procedure leading to 3 subgroups of 80 patients. Thrombolysis number and rate (among ischemic stroke), final NIHSS and status (alive or dead), acute hospital length of stay and cost were collected, including all early stage health care (MICU, ED, intensive care, stroke unit), not including long-term hospitalization and rehabilitation. Results : The 3 subgroups were comparable for all matching criteria: age 70 +/- 14 years, sex ratio = 40/40, ischemic/hemorrhagic = 55/25, initial NIHSS = 14.2, comorbidity = 2.2 +/- 1.2. Treatment requirements, outcome and cost of care referred to neurologic recovery varied greatly and signifi-cantly with delay of MICU arrival (p<0.01): Table I shows main differences among subgroups. Conclusion : MICU deals with severe stroke patients characterized by high NIHSS scores and im-portant treatment requirements. Acute hospital costs of care referred to one-point NIHSS retrieval are influenced by MICU delay, because as time passes, ability to restore neurologic function evapo-rates. This correlation between “time is brain” and “time is money” reminds us how short and pre-cious golden hours happen to be. Table I: Impact of MICU delay on outcome and cost of care referred to neurologic recovery “short” delay < 45 min. “medium” 45 min to 2 hours 468 © 2013 S. Karger AG, Basel Scientific Programme “long” delay > 2 hours Length of stay 10.6 days 12.1 days 12.1 days Thrombolysis (rate) n = 15 (27%) n = 7 (13%) n = 3 (6%) Final NIHSS (progress) 7.2 (-7.0) 8.7 (-5.5) 12.8 (-1.4) n improved NIHSS (rate) 58 (72%) 42 (52%) 21 (26%) n stable NIHSS (rate) 3 (4%) 7 (9%) 7 (9%) n deteriorated NIHSS (rate) 3 (4%) 11 (14%) 25 (31%) n patients who died (rate) 16 (20%) 20 (25%) 27 (34%) Cost of care per 1 NIHSS-point 2,300 € 3,500 € 15,000 € 347 Management and economics How well do Trial Outcome Measures Reflect Patients’ Quality of Life (QoL)? A Retrospective Analysis of Clinical Trial Data. M. Ali1, R. Fulton2, T. Quinn3, M. Brady4 on Behalf of the VISTA Collaboration Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian Uni-versity, Glasgow, UNITED KINGDOM1, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM2, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM3, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UNITED KINGDOM4 Background: The outcomes measured in randomised controlled trials (RCTs) should ideally rep-resent the full spectrum of stroke recovery, from impairment to societal participation. Quality of Life (QoL) is arguably the most important outcome for stroke survivors, but is often recorded as a secondary endpoint in RCTs. We described the relationship between QoL and other commonly employed stroke outcomes. Methods: We analysed data from the Virtual International Stroke Trials Archive (VISTA), including measures of physical impairment (NIHSS), activities of daily living (Barthel Index BI) and global disability (modified Rankin Scale mRS). We examined a generic health related measure (European Quality of Life Scale EQ-5D) and two forms of a stroke specif-ic measure (Stroke Impact Scale SIS). Using Spearman Correlations, we examined the relation-ships between QoL and standard outcome measures at 3 months, stratified by respondent (subject or proxy). We described the proportions with mRS≤1, NIHSS≤5 or BI≥95, who rated their QoL in the lowest 25% of the sample. Results: We analysed data from 3,857 subjects. QoL correlated best with mRS (EQ-5D weighted score p<0.0001, r=-0.7; SIS V3.0 Recovery p<0.0001, r=-0.71), while proxy responses were more closely correlated with BI (EQ-5D weighted score p<0.0001, r=0.78; SIS V3.0 Recovery p<0.0001, r=0.68; SIS-16 p<0.0001, r=0.92, Table 1). Fewer patients with mRS≤1 described poor QoL (EQ-5D weighted score=1.8%; SIS V3.0 Recovery=2.4%; SIS-16=0.9%), com-pared to those with NIHSS≤5 (EQ-5D Weighted Score =9.3%; SIS V3.0 Recovery=15.3%; SIS- 16=7.1%) or BI≥95 (EQ-5D Weighted Score =2.8%; SIS V3.0 Recovery=5.7%; SIS-16=1.2%). Conclusion: There was consistent correlation between primary outcomes and QoL scores; the stron-gest correlation was with mRS. Our results suggest that this assessment tool was more aligned with stroke survivors’ interests and further supports the preferential use of mRS as a primary outcome measure in stroke RCTs.
Karger_ESC London_2013
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