Schmidt Richard, Huber Charlotte, Pelz Johann Otto, Classen Joseph, Michalski Dominik
Department of Neurology, Medical Faculty, Leipzig University, Leipzig, Germany.
Institute for General Practice and Family Medicine, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany.
Neurol Res Pract. 2025 Jun 27;7(1):46. doi: 10.1186/s42466-025-00404-0.
Acute stroke care has evolved markedly in recent decades, yet long-term trends across stroke subtypes remain understudied. This study analyzed national trends in inpatient stroke care for ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in Germany from 2000 to 2021.
We conducted a retrospective analysis of nationwide hospital administrative data, assessing annual case counts, age-standardized rates, mean length of stay, and annual inpatient case days (AICD). Stroke unit (SU) treatments were analyzed from 2005 onward. Joinpoint regression identified changes in trends over time.
IS case rates, length of stay, and AICD declined significantly until 2005/2006, after which they stabilized at remarkably high levels. Paralleled by a rapid expansion of SU care, in-hospital mortality from IS decreased significantly. Coding of unspecified stroke (I64) declined steeply, suggesting shifts in diagnostic precision. In contrast, ICH and SAH showed falling case rates but increasing lengths of stay, particularly among deceased patients. SU treatments rose continuously from 2005 to 2021, with age-standardized rates increasing by 7.1% annually.
Over two decades, total inpatient burden from stroke has declined, primarily due to reductions in IS admissions and mortality. However, longer hospital stays in SAH and ICH and an overall rising SU care indicate shifting but consistently high resource requirements. Thus, continued efforts in optimizing healthcare infrastructure seem reasonable and should consider a subtype-specific resource allocation in acute stroke care.
近几十年来，急性中风护理有了显著发展，但中风亚型的长期趋势仍未得到充分研究。本研究分析了2000年至2021年德国缺血性中风（IS）、脑出血（ICH）和蛛网膜下腔出血（SAH）住院中风护理的全国趋势。
我们对全国医院管理数据进行了回顾性分析，评估了年度病例数、年龄标准化率、平均住院时间和年度住院病例天数（AICD）。从2005年起对中风单元（SU）治疗进行了分析。连接点回归确定了随时间变化的趋势。
IS的病例率、住院时间和AICD在2005/2006年前显著下降，之后稳定在相当高的水平。随着SU护理的迅速扩大，IS的住院死亡率显著下降。未明确的中风（I64）编码急剧下降，表明诊断精度发生了变化。相比之下，ICH和SAH的病例率下降，但住院时间增加，尤其是在死亡患者中。2005年至2021年，SU治疗持续增加，年龄标准化率每年增加7.1%。
二十多年来，中风的总住院负担有所下降，主要是由于IS入院人数和死亡率的降低。然而，SAH和ICH的住院时间延长以及SU护理总体上升表明资源需求在变化但持续很高。因此，继续努力优化医疗基础设施似乎是合理的，并且应该考虑在急性中风护理中进行亚型特异性资源分配。
