BACKGROUND AND PURPOSE
Treatment of stroke patients in specialized stroke units has become more frequent, yet the effect of this treatment has not been determined.
METHODS
In a community-based, prospective, and consecutive study of 1241 unselected acute stroke patients, we compared outcome of stroke treatment between two neighboring communities within Greater Copenhagen: the Bispebjerg community, where all acute stroke patients are treated and rehabilitated on a stroke unit, and Frederiksberg community, where all acute stroke patients are treated and rehabilitated on general neurological and medical wards. Except for the different organization of stroke treatment, the two communities and the two patient groups were comparable. Specifically, age, sex, marital status, prestroke residence, and stroke severity were not statistically different between patients treated on the stroke unit and those treated on the general neurological and medical wards. Multivariate regression analyses were used to estimate the independent influence of stroke unit treatment on outcome.
RESULTS
Stroke unit treatment significantly reduced in-hospital mortality (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.34 to 0.74; P < .001), case-fatality rate (OR, 0.45; CI, 0.28 to 0.71; P < .001), 6-month mortality (OR, 0.57; CI, 0.39 to 0.82; P = .002), 1-year mortality (OR, 0.59; CI, 0.42 to 0.84; P = .003), and discharge rate to a nursing home (OR, 0.61; CI, 0.38 to 0.98; P = .04). Discharge rate to the patient's own home was significantly increased (OR, 1.90; CI, 1.30 to 2.70; P < .001). The length of hospital stay (including rehabilitation) was reduced significantly by 30% in patients treated on the stroke unit despite their lower mortality (P < .001). The savings due to stroke unit treatment were estimated at 1313 bed-days and three places at a nursing home per 100 stroke patients.
CONCLUSIONS
Treatment of unselected acute stroke patients on a stroke care unit saved lives, reduced the length of hospital stay, reduced the frequency of discharge to a nursing home, and potentially reduced cost.
[1]
R. Stevens,et al.
A randomized controlled trial of a stroke rehabilitation ward.
,
1984,
Age and ageing.
[2]
I. Holme,et al.
Benefit of a stroke unit: a randomized controlled trial.
,
1991,
Stroke.
[3]
H. S. Jørgensen,et al.
Marked Increase of Stroke Incidence in Men Between 1972 and 1990 in Frederiksberg, Denmark
,
1992,
Stroke.
[4]
Lalit Kalra,et al.
Improving Stroke Rehabilitation: A Controlled Study
,
1993,
Stroke.
[5]
L. Kalra.
Does age affect benefits of stroke unit rehabilitation?
,
1994,
Stroke.
[6]
K. Asplund,et al.
A non-intensive stroke unit reduces functional disability and the need for long-term hospitalization.
,
1985,
Stroke.
[7]
R. Prescott,et al.
Management of acute stroke in the elderly: preliminary results of a controlled trial.
,
1980,
British medical journal.
[8]
P. Langhorne,et al.
Do stroke units save lives?
,
1993,
The Lancet.
[9]
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.