Consistency of the Benefits of Stroke Units over Years of Operation: An 8-Year Effectiveness Analysis

Abstract

Background: The efficacy of stroke units (SU) has been amply demonstrated in randomised trials. However, no long-term studies analysed their effectiveness in daily practice over several years of operation. Methods: Observational study from the stroke data bank of our neurology ward that includes consecutive stroke patients hospitalised since the SU was established in 1995 until the year 2002 (8 years). Clinical effectiveness was analysed in terms of mortality on day 7, in-hospital mortality, functional state at discharge, length of stay, in-hospital complications and long-term hospitalisation rates on a yearly basis using for comparisons χ² or Student t tests between the first and last 4 years of SU operation. Case-mix adjustments for baseline imbalances and stepwise multivariate logistic regression were also performed for comparative purposes. Results: 3,986 consecutive in-patients were included. No significant differences in the proportion of independent patients at discharge (73.9 vs. 74.5%; n.s.), length of stay (11.2 vs. 11.3 days; n.s.), in-hospital complications (25.0 vs. 25.9%; n.s.) or long-stay hospitalisation (6.3 vs. 6.4%; n.s.) were found comparing the first and last 4 years of SU operation. No significant differences in in-hospital mortality were found after adjustment by case-mix and length of stay. Conclusions: SU effectiveness, in terms of length of stay, death or dependence and long-term hospitalisation, is sustained over the period of operation.

Young Women Have Poorer Outcomes than Men after Stroke

“…This hospital is the only stroke center for a population of about 750,000. Data from stroke patients were prospectively collected from medical records and included in the stroke data bank as has been described previously [13]. A retrospective analysis of patients aged up to 50 years with a first-ever acute cerebral infarction was performed.…”

Relevance of Stroke Code, Stroke Unit and Stroke Networks in Organization of Acute Stroke Care – The Madrid Acute Stroke Care Program

“…This benefit is derived from noninvasive neurological monitoring and from the application of protocols of general care directed towards maintaining homeostasis, and the essential objective is to ensure a nonpharmacological neuroprotection as well as the correct application of specific treatments [28,29,30,31]. …”

“…Specialist attention is required during the entire disease process. The SU has been demonstrated to be the organizational model for most of the efficacious stroke care provision [28,29,30,31]. …”

General Care in Stroke: Relevance of Glycemia and Blood Pressure Levels

“…The best scenario in which to apply nonpharmacological brain protection is the nonintensive stroke unit (SU) [88]. Nonpharmacological brain protection in the SU has important benefits in terms of mortality, functional recovery, mean hospital stay, indices of chronic institutionalization and hospital costs [89,90,91,92,93,94], the benefits being maintained over the long term [95]. For a considerable period of time, early rehabilitation was considered most important as a determinant of its efficacy.…”