ESO East Supplement 2023 - 45

Tiu et al.
45
pathology as a primary diagnosis (therefore, obtaining a
higher case-mix index).
Specific
interventions such as
thrombolysis or thrombectomy for acute ischemic stroke did
not have, until recently, a corresponding code, and were
therefore unreported in this system. Data belonging to the
DRG-based system of county hospitals, collected through a
questionnaire dedicated to Neurology Departments from
these hospitals, show that between January and October
2016, 75,667 patients with acute stroke were hospitalized,
leading to an incidence of 408 acute stroke cases/100,000
people. Still, more recent data demonstrate a significantly
lower incidence, explained probably by the wrong classification
as acute strokes of patients with a history of stroke
hospitalized for other medical reasons. Data obtained by
direct interviews with the leading hospitals in the country,
which have departments of Neurology, show a total number
of 54,000 strokes in 2019. The reported number decreased
dramatically in 2020 and 2021 (with approximately 10,000
cases/year) due to the pandemic of Covid-19. A national
registry for cerebrovascular diseases is necessary, but the
authorities must support its management. In countries where
such registries are operative, they are adequately financed,
at least at the level of each healthcare institution.
The Romanian Ministry of Health initiated in 2011 a
pilot project in 10 stroke centers. This project was translated
in 2015 into a national health program, named Priority
Action for Interventional Treatment in Acute Stroke, dedicated
exclusively to financing the medication for intravenous
thrombolysis (IVT) and the devices necessary for
mechanical thrombectomy (MT) and endovascular treatment
of ruptured aneurysms (aneurysmal subarachnoid
hemorrhage). The decision was first published in 2015 as
an official order of the Ministry of Health (OMS No.
450/2015) and was republished several times as the number
of hospitals able to perform IVT or MT has increased. In
January 2019, a decision of the Ministry of Health in cooperation
with the Romanian Society of Neurology changed
overnight the availability of stroke-ready hospitals in
Romania by adding 32 new centers. The eligibility criteria
are mentioned in Table 1. Romania is administratively
organized into 42 units, 41 counties and the capital of the
country - Bucharest. The counties are unequally economically
developed and the situation is reflected in all levels of
stroke care, from primary prevention to life after stroke. In
April 2022, 46 centers (Figure 1) can perform IVT and only
five centers MT (only one has been added in 7 years). A
National Registry for Interventional Treatment in Ischemic
Stroke (IVT and MT) was established in 2014 and all procedures
are mandatory registered (www.neuroregistre.ro).
The registry is administered by the Romanian Society of
Neurology and has included 8213 IVT and 626 MT until
March 2022. The stroke incidence does not follow a uniform
distribution at the national level, being higher in the
Southern and Western regions. However, in the East and
Northeast regions the patients might have lower access to
hospital services and therefore some stroke cases could fail
to get admitted to Neurology departments and registered.
In the absence of a national stroke registry, the Registry
of Stroke Quality care (RES-Q), part of the ESO-EAST
project, was strongly supported by the Romanian Society of
Neurology (https://qualityregistry.eu/data/national_dashboard/).
The methodology for the registry was published
previously by Mikulik and colab.1
We started to introduce data in 2017, with 10 centers. In
2022 there are 36 centers (out of 46 able to deliver IVT)
that
register the patients discharged from the hospital
between March 1st and 31st with a diagnosis of TIA, acute
ischemic stroke, intracerebral hemorrhage, subarachnoid
hemorrhage, and cerebral venous thrombosis.
Besides the two mentioned sources (National Registry
for Interventional Treatment in Ischemic Stroke and RES-Q
Registry), our data come from a direct communication
inside the Romanian Stroke Network with the 46 local
coordinators of the Priority Action.
Between 2017 and 2022 a total number of 10,583
patients were registered in RES-Q, with the following distribution
which had small variations, determined by the
variability of hospital admittance: Transient ischemic attack
(3%, 9%, 5%, and 2%), ischemic stroke (80.6%-87.4%),
intracerebral hemorrhage (9.4%-13.4%), cerebral venous
thrombosis (0.2%-0.3%), undetermined (0.1%-0.2%), and
stroke mimics 0.3% (category introduced in 2022).
Gender
distribution is constant along the
years
(M = 51.4%, F = 48.6%), with median age 72 years for both
ischemic and hemorrhagic stroke.
Intravenous thrombolysis
In 2019 the Romanian Society of Neurology has published
as an order of the Ministry of Health the Standard Operating
Procedure (OMS No. 17/2019, Official Monitor Part I, No.
34, January 11th 2019) for the management of the interventional
treatment in acute ischemic stroke (both IVT and
MT) and aneurysmal subarachnoid hemorrhage. The document
covers prehospital and hospital procedures and was
essential for increasing the number of IVTs, as neurologists
felt more confident in applying a therapeutic method which
was new for them, having an official document to rely on.
Romania is confronted with a dramatic decrease in the
number of physicians due to a strong phenomenon of
migration. Even if the salaries have been raised since 2018,
the migration was not significantly influenced because one
of the main reasons is the pauper health system, with limited
resources and consequently poor conditions for a truly
professional performance.
Romania has a total number of 1285 neurologists,
according to the data obtained from the Romanian College
of Physicians. Neurologists are concentrated in university
centers and in more economically developed areas, being,
nevertheless, insufficient for the demand, even in these
https://www.qualityregistry.eu/data/national_dash-board https://www.qualityregistry.eu/data/national_dash-board http://www.neuroregistre.ro
ESO East Supplement 2023

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