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Updated: Aug 1, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Trying to understand routine stroke outcome data: the need for adequate casemix adjustment and some practical
N U Weir1, D F Signorini, M S Dennis
1Department of Clinical Neurosciences, Western General Hospital Crewe Road, Edinburgh.
Objective:
To determine how far the difference in published stroke case fatality between the Western General Hospital (WGH), Edinburgh and the Falkirk and District Royal Infirmary (FDRI) for the period 1990-93 can be explained by adjusting more fully for casemix.
Design:
The cases were ascertained and followed prospectively at the WGH and retrospectively at the FDRI; casemix correction was performed using a validated logistic regression model.
Setting:
The WGH is a teaching hospital and the FDRI a district general hospital.
Subjects:
Four hundred and thirty seven patients with a verified acute stroke at the WGH; 471 patients assigned a cerebrovascular disease discharge diagnostic code at the FDRI.
Outcome Measure:
Thirty day case fatality.
Results:
About half of the difference in the two hospitals' published stroke case fatality could be accounted for by variation in measured casemix. The residual difference in adjusted case fatality might have been due to differences in the structure of stroke care or simply to remaining differences in casemix. Full investigation of the cause was prevented by the destruction of the deceased patients records.
Conclusions:
Comparisons of routinely collected stroke outcomes will remain difficult to interpret unless casemix is properly accounted for and deceased patients' records stored for several years.
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