Benefit of a stroke unit: a randomized controlled trial.

Abstract

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 363% of the patients from the stroke unit and 50.0% from the general medical wards were in an institution (/>=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 173% 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. (Stroke

Manejo da hipertensão arterial na isquemia cerebral aguda

“…Só devemos nos preocupar com os níveis tensionais quando estão comprometendo órgãos vitais, ou seja, quando associados a: dissecção da aorta, com oclusão da artéria carótida comum e da artéria renal, insuficiência coronariana, encefalopatia hipertensiva, falência do ventrículo esquerdo e transformação hemorrágica de área isquêmica 7,9,10,15,19 . Usualmente a TA diastólica não deve exceder 120-140 mmHg, variando se o paciente era previamente hipertenso ou não 1,7,9,19,20 . Após a fase aguda compensatória os níveis tensionais tendem a se estabilizar 10,15,21 .…”

“…Assim, não havia indicação formal para redução imediata da TA à luz dos conhecimentos atuais 7,8,9,18,20,23 .…”

The early post-stroke mobilization

“…В двух исследованиях авторы сравни-вали раннюю мобилизацию в первые 3 сут после ин-сульта и позднюю, на 4-е сутки и позже. У пациен-тов из группы ранней мобилизации отмечалась меньшая степень инвалидизации, а также выше сте-пень подвижности и активности в повседневной жизни, в то же время уровень смертности не разли-чался в обеих группах [32][33][34][35][36][37][38][39]. Особого подхода тре-бует ранняя реабилитация пациентов с тяжелой со-путствующей патологией, в частности с хрониче-ской сердечной недостаточностью [40].…”

Stroke study group: preliminary results early intensive care improves functional outcome

“…Currently no single therapeutical measure gained wide consensus for routine use, but evidence suggests that early and intensive care positively influences outcome 5 1 3 . The experience of acute medical treatment combined with intensive rehabilitation measures in a "Stroke Unit" as reported 13 , seems to significantly affect functional state but remains inaccessible to most of our hospitals. Strategies to overlap our difficulties must include institution of standards of management with a well-trained team and rationale for cost-effective diagnostic and therapeutic measures in general hospital setting, outside of specialized units 5 .…”