Pathways to enhancing the quality of stroke care through national data monitoring systems for hospitals

To the Editor: Stroke care can only benefit from an integrated system for monitoring the quality of hospital care. However, in Cadilhac and colleagues' article,1 there appears a significant omission regarding the importance of correctly categorising stroke subtypes.

Categorising and including stroke subtypes is important, as the term stroke is poorly defined in the literature,2 and the advent of thrombolytic treatment has focused global research and public awareness campaigns on ischaemic events with the emphasis being on time to treatment and the provision of care within stroke units. The result of this has been a plethora of literature that identifies stroke solely with ischaemic events. The effect of this narrowed definition has been to focus attention and guidelines on ischaemic stroke, thereby disengaging other stroke subtypes that are generally not managed in mainstream stroke units, including haemorrhagic events and aneurysmal subarachnoid haemorrhage (aSAH), from being a “stroke”.

To avoid the misrepresentation of stroke as primarily an ischaemic event, haemorrhagic events need to be acknowledged in the literature. A clear context statement or definition of stroke will remove the ambiguity from the inclusion or exclusion of haemorrhagic events, particularly aSAH, in research and more significantly, in national data monitoring systems.

While the paper highlights that “much can be gained from bringing together diverse groups with a vested interest in a single, clinical population”, the population of haemorrhagic stroke patients must first be recognised and included.