|Professor Thanh Phan|
Mortality is an important metric for measuring hospital performance in treating patients with a disease. The usual method of estimating mortality in hospitals is to produce a standardised measure, adjusted for various patient health comorbidities. While this approach is widely used by groups such as Dr Foster Intelligence and Centres for Medicare and Medicaid Services, this approach is insufficient for stroke.
Published recently in the Journal of Stroke and Cerebrovascular Disease, researchers in the Stroke and Ageing Research Group at Monash University have revealed the optimal time for measuring stroke severity and the minimum clinical dataset for reliably predicting stroke mortality.
“Of particular significance, the predictors change depending on the time point for measuring mortality,” said study lead author Adjunct Clinical Professor Thanh Phan.
“Our analysis clearly shows that the measure of stroke severity, when incorporated into the model, substantially improves the accuracy of estimated stroke mortality over and above adjustment for comorbidities.”
Professor Thanh said this makes intuitive sense because a person with no comorbidities can have a major stroke and vice-versa.
“And post-stroke complications and mortality are also greater in patients with severe stroke.”
The research team also found that the measure of stroke severity used for predicting or estimating mortality is best obtained at 24 hours after stroke.
“24 hours is the critical time when neurological deficits have stabilised, and some patients who appear to have mild strokes at onset can progress to be more severe over 24 to 48 hours,” said Professor Thanh.
“Using stroke severity in addition to time-appropriate covariates such as age, gender, and comorbidity will enable more valid comparisons of hospital performance,” said Professor Velandai Srikanth, co-author and Head of the Stroke and Ageing Research Group.
“These results have the capacity to influence how hospital mortality is accurately estimated in patients with stroke.”
An acute stroke specialist and neurologist with clinical and research expertise in stroke thrombolysis, endovascular therapy and the management of transient ischaemic attack (TIA), Professor Phan is former Head of Stroke at Monash Health.