Stroke Incidence, Case Fatality, and Mortality Using the WHO International Classification of Diseases 11 : The Geneva Stroke Study

Article Article scientifique Article Stroke Incidence, Case Fatality, and Mortality Using the WHO International Classification of Diseases 11 : The Geneva Stroke Study eng 2025-02-18 2025-03-11 author Dirren Elisabeth Department of Neurology and Stroke Center, University Hospital, Geneva, Switzerland. 840921 author Escribano Paredes José Bernardo 0000-0003-0534-7962 Department of Neurology and Stroke Center, University Hospital, Geneva, Switzerland. 956906 author Klug Julian 0000-0002-4849-9811 Department of Neurology and Stroke Center, University Hospital, Geneva, Switzerland. 801527 author Barthoulot Mael Department of Clinical Epidemiology, University Hospital, Geneva, Switzerland. 425936 author Fluss Joel Victor 0000-0002-6413-162X Department of Pediatric Neurology, University Hospital, Geneva, Switzerland. 28801 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) author Fracasso Tony Department of Legal Medicine, University Hospital, Geneva, Switzerland. 731584 Institut de médecine légale (COLEG) author Kurian George Karun Department of Neurology and Stroke Center, University Hospital, Geneva, Switzerland. 844971 author Machi Paolo Department of Neuroradiology, University Hospital, Geneva, Switzerland. 860889 Département de radiologie et informatique médicale (RADIO) author Niederhauser Julien 0000-0002-6543-7989 Department of Neurology, GHOL, Nyon, Switzerland. author Suppan Laurent Department of Emergency Medicine, University Hospital, Geneva, Switzerland. 505697 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Sztajzel Roman Felix Hopital de la Tour, Meyrin, Switzerland; and. author Bijlenga Philippe Alexandre Pierre 0000-0002-3586-2757 Department of Neurosurgery, University Hospital, Geneva, Switzerland. 104899 Département des neurosciences cliniques (OTONO) author Carrera Emmanuel 0000-0003-0045-5382 Department of Neurology and Stroke Center, University Hospital, Geneva, Switzerland. 812606 Département des neurosciences cliniques (OTONO) e213353 10.1212/WNL.0000000000213353 39965170 0028-3878 Background and objectives: In the field of stroke epidemiology, one of the major advances in the recently implemented International Classification of Diseases, 11th revision (ICD-11) relates to the definition of ischemic stroke, which now includes events shorter than 24 hours when ischemia can be proven on brain imaging. However, data are scarce to ascertain the incidence of strokes of short duration with tissue evidence of ischemia. In this study, we determined the incidence, 30-day case fatality, and mortality rate of stroke in the Geneva population using the new ICD-11 criteria, taking advantage of the organization of stroke service in the area. Methods: In this population-based observational cohort study, we used data from the Swiss Stroke Registry, supplemented by hospital records, outpatient medical files, and autopsy, to identify residents of the canton of Geneva, Switzerland, meeting the ICD-11 criteria for first-ever stroke, including ischemic strokes, nontraumatic intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH), from January 1, 2018, to December 31, 2019. Results: We identified 1,186 first-ever strokes (75.8 years [interquartile range 63.4-84.5]; 571 women [48.1%]). MRI was performed in 90.9% of patients with ischemic strokes. The annual incidence of first-ever stroke, age-adjusted to the European Standard Population, was 127.0/100,000 (95% CI 119.8-134.3) (107.3 [100.7-114.0] for ischemic stroke, 13.2 [10.9-15.5] for ICH, and 6.0 [4.4-7.5] for SAH [3.1 {2.0-4.2} for aneurysmal SAH]). Overall, the 30-day case fatality was higher in ICH (32.5% [95% CI 19.7-38.8], compared with SAH (17.2% [6.6-27.9] and ischemic strokes 10.8% [8.4-12.4]). The incidence of ischemic stroke was 107.3 (100.7-114.0) according to ICD-11 and 90.4 (84.3-96.5) according to ICD-10 (excluding patients with radiologic infarct and symptoms lasting <24 hours). Compared with ICD-10, ICD-11 increased the number of ischemic stroke cases by 18.3%. Patients with ischemic strokes identified with ICD-11 but not under ICD-10 (i.e., patients with symptoms lasting <24 hours and a brain lesion) were younger and presented with a lower National Institutes of Health Stroke Scale (NIHSS) score on admission compared with those identified by ICD-10 and ICD-11. Discussion: The new ICD-11 clinicoradiologic definition of ischemic stroke increased the number of ischemic stroke cases by 18.3% in our Western European population. Future studies will evaluate the impact of ICD-11 on the human, organizational, and economic needs allocated to the management of the disease. Aged Aged, 80 and over Female Humans Male Middle Aged Cohort Studies Incidence International Classification of Diseases Ischemic Stroke / mortality Ischemic Stroke / epidemiology Registries / statistics & numerical data Stroke / mortality Stroke / epidemiology Subarachnoid Hemorrhage / mortality Subarachnoid Hemorrhage / epidemiology Switzerland / epidemiology World Health Organization Dewey 616.8 Dewey 616.0757 Dewey 614.1 Dewey 617 Dewey 618 Swiss National Science Foundation Manipulating the peri-infarct cortex using Maraviroc to enhance motor skills after stroke 215285 CH 61 Département des neurosciences cliniques 226 217 Centre de recherche clinique 201 58 Département de pédiatrie, gynécologie et obstétrique 223 67 Institut de médecine légale 22A2 62 Département de radiologie et informatique médicale 227 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 1416 Accident vasculaire cérébral 1049 953 Groupe Fracasso Tony 959 513 Groupe Schaller Karl Lothard (neurochirurgie) 851 Neurology 104 5 beb5fc4a-648f-4749-8b94-6ecd6407878f Article (Published version) Restricted 00006114-202503110-00049.pdf 433986 application/pdf d23fb931819e300e86020d1fc7779c815ed35d4251e554a75798acdb601835df 10d1d0ad-975b-4e4c-ac21-f87819f8cc2c Supplemental data Restricted supplements-1.pdf 1509302 application/pdf Originally wrong version published 9c2b0105fa7ceb866d420a8b85db99ad0549739a35ee4ede32ce6b96cb1c6a69 5b8aef94-3c1a-43cb-8ffc-6ef1ff93e6a7 Supplemental data Restricted supplements-3.pdf 504941 application/pdf Corrected supplementary version 9c100b104e43a7c795081fb8e3e57acbe1418b4d3ddcfb9543b25dc7ea17c8f7 f19390ee-d422-426c-b40e-a39b956aa4b7 Erratum Restricted dirren-et-al-2026-stroke-incidence-.pdf 50379 application/pdf 7188ac7158b66df1fa8f2601afa16e579077bdb266e5bb74d9412eb38eceba83 The wrong version of the Supplementary Materials file was originally published. The correct version (with updates to eAppendix 1 and eTables 1–2, 4–7) is included with this Correction online. 10.1212/wnl.0000000000214814 41747207 restrictedAccess Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques Faculté de médecine / Centre de recherche clinique Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de médecine légale Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Stroke Incidence, Case Fatality, and Mortality Using the WHO International Classification of Diseases 11 : The Geneva Stroke Study	Neurology			2025	13	0

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