Benefit of a stroke unit: a randomized controlled trial.

In a randomized controlled trial we compared the clinical outcome of acute stroke patients, 110 of whom were allocated to treatment in a stroke unit and 110 to treatment in general medical wards. No significant difference existed between these groups with regard to sex, age, marital status, medical history, or functional impairment on admission. Outcome was measured at 6 and 52 weeks after the stroke by the proportion of patients at home, the proportion of patients in an institution, the mortality, and the functional state. After 6 weeks 56.4% of the patients randomized to the stroke unit and 32.7% of the patients randomized to the general medical wards were at home (p = 0.0004), and after 52 weeks 62.7% and 44.6%, respectively, were at home (p = 0.002). After 6 weeks 36.3% of the patients from the stroke unit and 50.0% from the general medical wards were in an institution (p = 0.02); after 52 weeks 12.7% and 22.7%, respectively, were institutionalized (p = 0.016). After 6 weeks mortality was 7.3% for the stroke unit group and 17.3% for the general medical wards group (p = 0.027). After 52 weeks mortality was 24.6% for the stroke unit group and 32.7% for the general medical wards group (difference not significant). Functional state was significantly better for patients treated in the stroke unit after both 6 and 52 weeks. We conclude that care of patients with acute stroke in a stroke unit improves clinical outcome compared with treatment in general medical wards.

[1]  F. Mahoney,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 2018, Maryland state medical journal.

[2]  E. Ernst,et al.  A review of stroke rehabilitation and physiotherapy. , 1990, Stroke.

[3]  Lippincott Williams Wilkins,et al.  Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. , 1989, Stroke.

[4]  B. Dobkin.  Focused stroke rehabilitation programs do not improve outcome. , 1989, Archives of neurology.

[5]  M. Reding,et al.  Focused stroke rehabilitation programs improve outcome. , 1989, Archives of neurology.

[6]  J. Grotta.  Current medical and surgical therapy for cerebrovascular disease. , 1987, The New England journal of medicine.

[7]  K. Asplund,et al.  Stroke unit care--who benefits? Comparisons with general medical care in relation to prognostic indicators on admission. , 1986, Stroke.

[8]  M. Dombovy,et al.  Rehabilitation for stroke: a review. , 1986, Stroke.

[9]  V. Hachinski,et al.  Stroke units or stroke centres? , 1986, Stroke.

[10]  Lippincott Williams Wilkins,et al.  Multicenter Trial of Hemodilution in Ischemic Stroke — Background and Study Protocol , 1985, Stroke.

[11]  M. Garraway.  Stroke rehabilitation units: concepts, evaluation, and unresolved issues. , 1985, Stroke.

[12]  S. Shapiro,et al.  PA Randomized Trial of Team Care Following Stroke , 1984, Stroke.

[13]  R. Stevens,et al.  A randomized controlled trial of a stroke rehabilitation ward. , 1984, Age and ageing.

[14]  R J Jarrett,et al.  Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study. , 1983, British medical journal.

[15]  F. Plum,et al.  Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. , 1983, The American journal of medicine.

[16]  J. D. Wallace,et al.  Blood pressure after stroke. , 1981, JAMA.

[17]  R. Prescott,et al.  Management of acute stroke in the elderly: follow-up of a controlled trial. , 1980, British medical journal.

[18]  D. Sherman,et al.  Management of cerebral embolism of cardiac origin. , 1980, Stroke.

[19]  H. J. Gelmers.  Effects of low‐dose subcutaneous heparin on the occurrence of deep vein thrombosis in patients with ischemic stroke , 1980, Acta neurologica Scandinavica.

[20]  R. Prescott,et al.  Management of acute stroke in the elderly: preliminary results of a controlled trial. , 1980, British medical journal.

[21]  V. Hachinski,et al.  Intensive Care Management of Stroke Patients , 1976, Stroke.

[22]  W. E. Drake,et al.  Acute Stroke Management and Patient Outcome: The Value of Neurovascular Care Units (NCU) , 1973, Stroke.

[23]  F. Kennedy,et al.  Stroke intensive care--an appraisal. , 1970, American heart journal.

[24]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[25]  K. Asplund,et al.  A non-intensive stroke unit reduces functional disability and the need for long-term hospitalization. , 1985, Stroke.

[26]  K. Lind.  A synthesis of studies on stroke rehabilitation. , 1982, Journal of chronic diseases.

[27]  J. Feigenson,et al.  Stroke rehabilitation. II. Guidelines for establishing a stroke rehabilitation unit. , 1977, New York state journal of medicine.