Acute neurological stroke care in Europe: results of the European Stroke Care Inventory M. Brainin, N. Bornstein, G. Boysen and V. Demarin for the EFNS Task Force on Acute Neurological Stroke Care © 2000 EFNS 5 Prevention and treatment of stroke have become rec- ognized health priorities in most European countries. Epidemiological studies have shown that incidence, prevalence and mortality differ widely throughout Europe, and the increasing socioeconomical burden resulting from stroke disability also shows marked dif- ferences between eastern and western European coun- tries (Thorvaldsen et al., 1995; Asplund et al., 1996; Asplund, 1996). Population-based epidemiological studies that have a methodological quality which allows an estimate for future trends have only been few and are limited to comparatively small regions in Europe (Sudlow and Warlow, 1997). In spite of increased efforts to compile such data for other European regions (Beech et al., 1996; Feigin et al., 1996; Stegmayr et al., 1996; Ryglewicz et al., 1997), no exact data will become available for most of Europe in the near future. Even fewer data exist on the quantity and quality of stroke care and management within Europe. Because of these unmet needs the EFNS Task Correspondence: Professor Michael Brainin, Center for Postgraduate Studies in Neuroscience, Danube University, Department of Neurology, Landesnervenklinik, Hauptstrasse 2, A-3400 Maria Gugging, Austria (fax: +43 224390555 338; e-mail: brainin@ donau-uni.ac.at). Received 23 September 1999 Accepted 7 December 1999 Following the 1997 Recommendations of the EFNS Task Force on Acute Neurological Stroke Care (European Journal of Neurology, 1997: 4:435–441) a European Inventory was undertaken to assess the development of acute stroke care in the EFNS member countries and to give an estimate of the needs based on 1997 data. All 30 members of the EFNS Stroke Scientist Panel were asked to complete a ques- tionnaire on acute stroke epidemiology as well as acute stroke care in their country. Data were based either on national surveys, hospital statistics, or estimates given on the basis of extrapolation of regional studies, or other defined sources. Specialist esti- mates were also taken into account where no other data source was available. Data from 22 countries were received and referred to almost one million strokes occurring per year in a population of over 500 million. Most epidemiological data confirmed an east–west gap known from previous studies. These included rates that, in eastern countries, were higher for incidence, stroke as a leading cause of death, and 30-day case-fatality, and rates that were lower for overall hospitalization or availability of CT scanning. East–west differences were not seen for the total num- ber of acute stroke units or the number of acute stroke units set up within neuro- logical hospital departments, nor for most other quality indicators of acute stroke care with the exception of technological standards in some countries. The higher rates for 30-day case-fatality in eastern Europe (mostly above 20%) compared with western Europe (mostly below 20%) are probably caused by a case mix with more severe ischemic strokes and a higher percentage of cerebral haemor- rhages admitted for acute care in eastern Europe. This is probably due to the high- er prevalence of the most common risk factors for stroke in these countries which tend to result in more severe strokes. This, therefore, underlines the need for stroke prevention programmes especially in eastern Europe. This epidemiological east–west gap is not reflected by most quality indicators for acute stroke care, e.g. total number of acute stroke units available within each country. Most eastern European countries have a well-developed neurological care system for acute stroke but still have urgent technological and socioeconomical needs. The leading role of clinical neurology in acute stroke care is visible in most but not all European countries. REVIEW