Das Stroke-Unit-Konzept in Deutschland und Europa

 

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Zusammenfassung

Die Stroke Unit ist eine Krankenhausstruktur, die in ihrer Gesamtheit als Akut- und Subakut- Therapeutikum wirkt. Gleichzeitig dient sie als Organisationszentrale für das Management des Schlaganfallpatienten in der gesamten Versorgungskette. Die Wirksamkeitsprinzipien der Stroke-Unit-Behandlung sind durch Studien untermauert und umfassen die ausschließliche Behandlung von Schlaganfallpatienten in dieser Einheit, den Einsatz eines multiprofessionellen Teams und die Kombination von Akuttherapie und früher Mobilisations- und Rehabilitationsbehandlung. Eine- Metaanalyse zeigte, dass Patienten, die in Stroke Units behandelt wurden, nach einem Jahr hochsignifikant häufiger überlebt hatten (21% weniger Todesfälle) und auch im Hinblick auf ihre Behinderung signifikant besser abschnitten (13% weniger Abhängigkeit von anderen). Diese Senkung von Tod und Abhängigkeit ist auch zehn Jahre nach Behandlung auf der Stroke Unit noch nachweisbar. In Stroke Units entwickelt sich eine besondere Expertise in der Thrombolysetherapie des Hirninfarktes mit eindeutigen Mengeneffekten. Je häufiger diese Therapie an einem Zentrum durchgeführt wird, um so geringer ist die Letalität. Dieses Ergebnis wurde nicht nur in Deutschland, sondern auch in anderen Ländern gefunden. Verbesserte Infrastrukturen mit hohem Patientendurchsatz schaffen generell besondere Expertise, und die Patienten werden wirkungsvoller behandelt. Über das Benchmarking der Stroke Units wird ein kontinuierliches Qualitätsmanagement mithilfe der Arbeitsgemeinschaft Deutscher Schlaganfallregister anhand definierter Qualitätsindikatoren sichergestellt. In Deutschland werden in Kürze über 200 zertifizierte Stroke Units aktiv sein. Hieraus lässt sich abschätzen, dass bundesweit mindestens 60% der Schlaganfallpatienten in zertifizierten Stroke Units behandelt werden.

Summary

A Stroke Unit is a hospital infrastructure which operates as an acute and subacute therapeutic. Simultaneously, stroke units serve as logistic centers to organise stroke patient management in a chain of care. The effectiveness of stroke unit treatment has been proven by trials. The cornerstones of efficacy are the exclusive treatment of stroke patients in this unit, the treatment by a multi-professional team and the combination of peracute and acute therapy with early mobilisation and rehabilitation. A meta-analysis showed that patients treated in Stroke Units had survived significantly more often (21% less deaths) and were significantly less frequently disabled (13% less dependency) compared to patients not treated on stroke units. Ten years later, these benefits are still measurable. Stroke units provide an ideal basis for the development of expertise in performing thrombolytic therapy. There is a clear correlation between higher numbers of fibrinolytic treatment per year and better outcomes in particular lower mortality. This result was not only found in Germany but also in other countries. Improved organisation and smooth infrastructure of stroke units lead to higher numbers of patients, enhanced expertise and better treatment in general. Classical benchmarking of certified German stroke units is provided with the help of the data bank of the Cooperative of German Stroke Registries. A continuously improved quality management according to consented quality indicators is also warranted. 200 certified Stroke Units will become active in Germany in the near future. This means that actually at least 60% of all stroke patients will be treated in these Stroke Units.

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