Trends in Acute Inpatient Stroke Care in Germany An Observational Study Using Administrative Hospital Data From 2005-2010

Background: Administrative hospital data can be used to detect trends in the care of patients hospitalized with acute stroke. Methods: The nationwide German DRG statistics for the years 2005 to 2010 were used to identify hospitalizations for acute stroke. All hospitalizations of patients with a principal diagnosis of acute stroke who were over 19 years old on admission were included in the analysis; admissions transferred from other acute care hospitals were excluded. The data were analyzed to determine annual hospitalization rates, characteristics of the patients and hospitals, patterns of care, and in-hospital mortality. Results: The number of hospitalizations for acute stroke in Germany per year ranged from 235 000 in 2005 to 243 000 in 2010. After standardization for the age and sex structure of the population 2005, the annual hospitalization rate was found to have declined over the period of the study from 357 to 336 hospitalizations per 100 000 persons. The decline occurred mainly in older patients (in men from age 60 and in women from age 70 onward). The percentage of patients cared for in a stroke unit ("complex treatment" in the coding system of the German Classification of Operations and Procedures [Operationen-und Prozedurenschlussel, OPS]) rose from 15% to 52%. The percentage of patients with cerebral infarction who received systemic thrombolytic treatment rose from 2.4% to 8.9%. In-hospital mortality declined from 11.9% in 2005 to 9.5% in 2010, with a standardized 2005-versus-2010 mortality ratio of 0.79. Conclusion: The declining hospitalization rate of elderly patients might reflect the impact of better primary and/or secondary prevention. The findings also reveal a trend toward more specific care for acute stroke, which may be the cause of the observed decline in in-hospital mortality.