Do Acute Stroke Units Improve Care?

Abstract

Background and Purpose: Stroke rehabilitation units have been shown to improve mortality and reduce morbidity and hospital length of stay as compared with conventional medical ward care. In contrast, the effectiveness of acute stroke units (ASUs), which only provide early in-patient care, is unknown. We have compared ASU care with that administered on a general medical or geriatric ward. Methods: Historical comparison of 116 consecutive patients admitted to a new ASU during the 6-month period from February to July 1994 with 128 consecutive patients admitted to general medical or geriatric wards during the previous 6-month period (August 1993 to January 1994). Results: Admission baseline characteristics were similar between the two groups. As compared with conventional general ward care, patients admitted to the ASU had a shorter stay in casualty, 6 h (4–6) versus 7 h (4–11; 2p = 0.03); reduced length of stay in hospital, 20 days (10–55) versus 31 days (13–80; 2p = 0.09); increased carotid Doppler investigation, 40/94 versus 25/101 (2p = 0.013); increased prescription of secondary prevention measures, aspirin 49/94 versus 33/101 (2p = 0.009) or treatment of hypertension 19/50 versus 5/47 (2p = 0.004); improved outcome, home: institution: death, 69:11:18 versus 63:13:32 (2p = 0.049). Conclusion: ASUs appear to contribute to improved care (investigations, secondary prevention) and outcome following stroke whilst patients spend less time in hospital.

Misdiagnoses in 1,250 Consecutive Patients Admitted to an Acute Stroke Unit

“…Examination of the patient by the board-certified neurologist at admission in the emergency department [3] would probably have led to an increased delay of admission to the acute stroke unit: besides providing care to stroke patients, the board-certif ied neurologist also must manage other neurological emergencies occurring in the hospital. Increasing the length of stay in the emergency department would have led to a decreased availability of beds, practitioners and paramedical staff.…”

“…Over the last 10 years, a better knowledge of the pathophysiology of ischemic stroke and the development of drug trials with fibrinolytic drugs and neuroprotectors have emphasized a need for intervention within the very first hours of stroke onset [ 1 ]. Although no drug has yet clearly proven to be effective in reducing mortality and disability, after stroke at the acute stage, recent statistical overviews provided compelling evidence that patients admitted to stroke units are less likely to die and to have residual disability [2,3], A meta analysis of 10 randomized trials showed that mortality within the first 4 months after a stroke was reduced by 28% in patients allocated to a stroke unit compared with those allocated to a general ward, and this mortality bene fit persisted to 12 months [2], Moreover, treatment of stroke patients over 65 years [4] in a neurological ward rather than in a general ward significantly reduced the length of hospital stay by over 2 weeks: those treated by a neurologist are more often discharged directly home and had a better Rankin score at 1 year [4]. The reason for the effectiveness of stroke units in reducing mortality and dis ability remains unsettled.…”

Ten Questions to Stroke Units

“…usually within 7 days. Acute stroke units seem to improve care by providing examinations as well as secondary prevention, thus reducing length of stay [7].…”

Management soon after a stroke

“…Admission to an acute stroke unit (providing specialist assessment and early treatment) for a few days probably improves both the short- and long-term clinical outlook 12 , 13. Much clearer is evidence indicating that inpatients with a wide range of severity of disability following stroke benefit from transfer to a unit that provides multidisciplinary rehabilitative care, either alone (rehabilitation stroke unit) or with acute care (a combined acute/rehabilitation unit).…”