ESO East Supplement 2023 - 13

Palaiodimou et al.
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source of selection bias during registry inclusion, since
patients with severe stroke or speech disorder may have not
been able to consent. In such cases, the legal representatives
were asked to provide informed consent for participation.
COVID-19 pandemic-associated restrictions may
have limited patient participation considering that legal
representatives and/or family member may have not been
allowed escorting stroke patients in certain hospitals.
Nevertheless, the number of registered patients has not
been reduced during the COVID-19 pandemic.
Furthermore, as we have already mentioned, not all
institutions in Greece treating acute stroke patients have
participated in the RES-Q registry, and the data captured
may not be representative for the entire Greek population,
especially when urban and rural areas are compared. Given
the high incidence of stroke in Greece, the number of total
registered patients throughout the 5-year period is low. It
should be highlighted, though, that registry participation
for stroke centers in Greece has been investigator-initiated
and voluntary, while there are no stakeholders involved to
support this initiative. Registry maintenance has been challenging
and temporal dropouts were noticed during the
5-year period in all but two sites, that managed to include
more than 95% of the discharged stroke patients in the
RES-Q registry. Mandatory reporting of quality indicators
and the introduction of a benchmarking system providing
continuous feedback among participating centers have been
shown to promote stroke care in other health systems,34 and
have also been a matter of discussion between the stroke
scientific community and the policy makers for future
implementation in Greece. Importantly, as part of the
national stroke action plan and re-organization, the minimal
requirements for dedicated stroke centers regarding healthcare
personnel and technical equipment are being set and
are expected to be adopted and periodically audited by
national authorities.
Another shortcoming is that data regarding symptomatic
ICH after receiving reperfusion therapy were not collected
in RES-Q registry; thus, safety outcomes reporting was
limited to in-hospital mortality, which did not differ
between treated versus not treated AIS cases. Finally,
RES-Q registry is based on self-reporting by the participants,
and impact of missing data and possible reporting
bias cannot be ignored. Nevertheless, to our knowledge,
this is the first study that presents the overall management
of acute stroke patients in multiple centers across all
Greece. The real-world data provided in our study confirm
the efficacy of acute reperfusion therapies in AIS in Greece
and further highlight the need for development of stroke
infrastructure that will accommodate the prompt delivery
of acute treatment in stroke patients improving the clinical
outcomes at discharge. Therefore, despite potential limitations,
the importance of our study lies in informing and further
guiding future actions to be undertaken in order to
optimize stroke management in Greece.
Conclusions
Participation in a nationwide stroke registry should be encouraged
for all sites managing patients with acute stroke in
Greece, including primary and comprehensive stroke centers
and stroke-ready hospitals across the whole country. Broader
implementation through incentives provided by stakeholders,
quality benchmarking between participating centers that is
encouraged by national authorities and further expansion of
the RES-Q registry in collecting additional quality metrics
will guide the stroke management planning to widen the
availability of swift patient transportation, delivery of acute
reperfusion therapies, and stroke unit hospitalization.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Ethical approval
The study was approved by the local Ethics Committee of
" Attikon " University Hospital (decision number EBΔ37) which
was the coordinating center of the RES-Q registry in Greece.
Informed consent
Signed informed consent was obtained from the patients or their
legal representatives before enrollment in all cases.
Guarantor
Georgios Tsivgoulis, MD.
Contributorship
LP and GT contributed to conception and study design. LP, OK,
AHK, AK, EB, AK, VZ, KN, GP, AT, CZ, AS, KP, EN, PP, GK,
AM, MK, CL, IK, VG, AS, AR, GK, PP, SP, MG, AT, DK, TK,
GM, SG, and GT contributed to acquisition and analysis of data.
LP, OK, AHK, and GT contributed to drafting a significant portion
of the manuscript or figures. EB, AK, VZ, KN, GP, AT, CZ,
AS, KP, EN, PP, GK, AM, MK, CL, IK, VG, AS, AR, GK, PP,
SP, MG, AT, DK, TK, GM, and SG contributed with critical comments
during manuscript revision. All authors approved the submitted
manuscript.
ORCID iDs
Lina Palaiodimou
Evangelos Ntais
8140
Sotirios Giannopoulos
5179
https://orcid.org/0000-0001-7443Panagiotis
Plomaritis
Georgia Karamatzianni
https://orcid.org/0000-0001-7757-609X
https://orcid.org/0000-0001-6739-6108
https://orcid.org/0000-0003-2420-9485
https://orcid.org/0000-0002-7496
https://www.orcid.org/0000-0001-7757-609X https://www.orcid.org/0000-0001-6739-6108 https://www.orcid.org/0000-0003-2420-9485 https://www.orcid.org/0000-0002-7496-8140 https://www.orcid.org/0000-0002-7496-8140 https://www.orcid.org/0000-0001-7443-5179 https://www.orcid.org/0000-0001-7443-5179
ESO East Supplement 2023

Table of Contents for the Digital Edition of ESO East Supplement 2023
