ESO East Supplement 2023 - 7

Palaiodimou et al.
7
Data collection
Demographic characteristics (age, gender) were collected
for all included patients. Furthermore, the baseline characteristics
of the index event were also recorded, including
stroke type, date and time of stroke onset, hospital admission,
and initial stroke severity, as assessed by certified
neurologists using the National Institute of Health Stroke
Scale (NIHSS) score.16 Acute management at the ER was
registered, including prompt imaging evaluation (defined
as a CT/MRI brain imaging within 1 h from ER admission)
and acute reperfusion therapy in cases of AIS. All patients
were treated according to the standard of care.17-20
Specifically, in cases of AIS, intravenous thrombolysis
(IVT), endovascular treatment (EVT), or bridging therapy
(i.e. combination of IVT and EVT) was offered according
to current guidelines and site availability.21-23 Time metrics,
such as door to needle (DTN) time and door to groin puncture
(DTG) time, were registered in the cases that acute reperfusion
treatment was performed.
Subacute management and further assessment during
hospital admission were also recorded. Hospitalization in a
stroke unit or intensive care unit (ICU), need for mechanical
ventilation, rehabilitation assessment and screening for
dysphagia, atrial fibrillation (AF), and carotid arteries stenosis
were among the included variables in the registry.
Status regarding Coronavirus Disease 2019 (COVID-19)
during the years of the pandemic (2020-2021) was also
recorded. Discharge destination and medical instructions at
discharge, including drug prescriptions (anithrombotics,
statins, antihypertensives), smoking cessation, and scheduled
follow-up appointments were collected.
The outcomes of interest were the clinical outcomes at
discharge, which were assessed and recorded using the
modified Rankin scale (mRS).24 An excellent clinical outcome
was defined as an mRS score of 0 or 1 and a good
clinical outcome (FI) was defined as an mRS score between
0 and 2.25,26
Statistical analyses
Categorical variables are presented as number of patients
with the corresponding percentages. Continuous variables
are presented as mean ± standard deviation (normal distribution)
and as median with interquartile range (IQR,
skewed distribution). Statistical comparisons between categorical
variables were performed using χ2 test, or in case
of small expected frequencies, Fisher's exact test.
Continuous variables were compared using the unpaired
t-test or Mann-Whitney U test, as indicated. Acute reperfusion
treatment rates in AIS patients were compared between
two specified time epochs (2020-2021 vs 2017-2019),
after adjustment for contributing sites, using the CochranMantel-Haenszel
test and generating an adjusted odds ratio
(OR) with corresponding 95% confidence intervals (CI).
A propensity score matching (PSM) analysis was applied
for the assessment of reperfusion treatment and clinical outcomes
at discharge specifically for the AIS patients.27 After
dichotomization according to receiving acute reperfusion
treatment, patients in the treatment group (patients receiving
reperfusion treatment) were matched to control group
patients (patients not receiving reperfusion treatment). For
matching, a propensity score model was used, including all
baseline characteristics, initial stroke severity, and site of
admission. The corresponding propensity score of the treatment
variable (acute reperfusion treatment) was calculated
for each subject and a nearest neighbor matching algorithm
with a 1:1 allocation was subsequently implemented to
match eligible patients in the treatment group to patients in
the control group.28 To determine whether the propensity
score matching approach achieved balance in all potential
confounders, we compared all baseline characteristics of
patients in the treatment group to their control patients,
before and after propensity score matching.29,30 In the propensity
score matched groups, the ORs with corresponding
95% CIs were calculated for the following outcome events
of interest: (1) excellent clinical outcome rates at discharge;
(2) good clinical outcome rates at discharge; and (3) functional
improvement at discharge quantified by the distribution
of 3-month mRS scores between the two groups using
ordinal logistic regression analysis.
Statistical significance was achieved if the p value was
⩽0.05. Statistical analyses were performed with the
Statistical Package for Social Science (SPSS Inc, Armonk,
NY, US; version 23.0 for Windows) and RStudio: A
Language and Environment for Statistical Computing (R
Foundation for Statistical Computing, Vienna, Austria),
with the use of the " MatchIt " package (matching software
for causal inference) for matching patients across the two
groups.
Data availability statement
All data generated or analyzed during this study are available
from the corresponding author upon reasonable request.
Results
Twenty sites in Greece (Figure 1) that are responsible for
the management of stroke patients in the acute setting have
contributed with data in the RES-Q registry during the
years
2017-2021. Two centers
(University
Hospital
" Attikon " and Metropolitan Hospital Peiraeus) have maintained
patient registration throughout a 5-year duration.
Three centers registered patients for 4 years, while the rest
continued patient registration for 3 years or less. However,
the absolute number of patient registration has remained
stable throughout those years (Table 1).
Overall, 3590 patients were prospectively registered
(61% men, median age 64 years (IQR 55-74)). 74% of
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