Do all ischemic stroke subtypes benefit from organized inpatient stroke care?

Smith, Eric E.; Hassan, Khalid Ali; Fang, Jiming; Selchen, Daniel; Kapral, Moira K.; Saposnik, Gustavo

doi:10.1212/wnl.0b013e3181ebdd8d

Cited by 55 publications

(36 citation statements)

References 19 publications

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“…Data in the literature lends support to our work since it has been shown that the control of vascular risk factors [12,19]; the use of antihypertensive therapy, antiplatelets and statins [3]; and a multidisciplinary follow-up of patients at home [3,7,10] or some hospital-based stroke services [20] combine to reduce the risk of recurrence. This change is similar to the benefit observed in all ischemic strokes from organized inpatient stroke care [21]. …”

Section: Discussionsupporting

confidence: 80%

Evaluation of the Possible Impact of a Care Network for Stroke and Transient Ischemic Attack on Rates of Recurrence

Raffe

Jacquin²,

Milleret³

et al. 2011

Eur Neurol

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We aimed to demonstrate that a stroke network is able to reduce the proportion of recurrent cerebrovascular events. In 2003, we set up a care network with the aim to reduce the proportion of stroke recurrence. For the statistical analysis, recurrent cerebrovascular events observed from 1985 to 2002 within the population of Dijon made it possible to model trends using Poisson logistic regression. From 1985 to 2002, we recorded 172 recurrent cerebrovascular events which were used to model trends before the creation of the care network. Within the period 2003–2007, we observed 162 recurrent cerebrovascular events compared with 196.7 expected cerebrovascular events with a significant standardized incidence rate of 0.82 (0.70–0.96; p = 0.01). After eliminating the role of some environmental factors, the possible hypothesis for the fall in recurrent stokes is probably the positive effect of the stroke care network.

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Section: Discussionsupporting

confidence: 80%

Evaluation of the Possible Impact of a Care Network for Stroke and Transient Ischemic Attack on Rates of Recurrence

Raffe

Jacquin²,

Milleret³

et al. 2011

Eur Neurol

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“…[25][26][27][28] One study found that stroke units improve the outcome in patients with large-vessel infarcts, but not in those with lacunar syndromes. 28 Analyses of organized stroke care in Can- ada show that all age groups and stroke subtypes benefit from organized care, even after adjusting for stroke severity.…”

Section: Resultsmentioning

confidence: 99%

“…28 Analyses of organized stroke care in Can- ada show that all age groups and stroke subtypes benefit from organized care, even after adjusting for stroke severity. 26,27 Additional work found that an increasing level of organized care was associated with improved survival after stroke. 25 There was heterogeneity in hospital performance within certification categories as well as overlap between JC-certified PSC and noncertified hospitals.…”

Section: Resultsmentioning

confidence: 99%

Outcomes after ischemic stroke for hospitals with and without Joint Commission–certified primary stroke centers

Lichtman¹,

Jones²,

Wang³

et al. 2011

Neurology

119

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“…[1][2][3][4][5][6][7] The Cochrane review of randomized controlled trials have shown that establishment of SUs decrease both death and dependency. 3 Also, care in an SU results in an improved outcome irrespective of age or sex of the patient, 4 stroke subtype (including hemorrhage) or severity of the insult, 4,6 and whether the unit has advanced monitoring equipment. 3 Although some studies suggest that the length of stay (LOS) in hospital is not reduced, 7 others suggest that LOS may be significantly reduced in admission to SUs.…”

mentioning

confidence: 99%

Beneficial Effects of Implementing Stroke Protocols Require Establishment of a Geographically Distinct Unit

Akhtar

Kamran

Singh

et al. 2015

Stroke

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Background and Purpose— Usefulness of multidisciplinary stroke units in acute stroke patients is well established. There is extensive western literature on usefulness of stroke units in outcome, but limited evidence from the rest of the world. We aim to evaluate the impact of establishing a stroke unit on outcome in patients presenting to a tertiary care facility. Methods— This is a retrospective study of 1003 patients with acute stroke admitted to Hamad General Hospital, Qatar, between January 2014 and February 2015. Patients directly admitted to intensive care unit (132) were excluded. We compared outcomes of pre- and poststroke ward (SW) establishment and in SW patients versus those of general medical wards. Results— Before the establishment of the SW, 175 patients were admitted to the hospital. From April 2014 to February 2015, 696 patients were admitted (SW, 545; medical ward, 151). There was a significant reduction in length of stay from 14.7±27.7 to 6.2±20.2 days ( P =0.0001) and incidence of complications (23.6% versus 6.4%, P =0.0001) after implementation of stroke-specific protocols. Prognosis at discharge (modified Rankin Scale 0–2 in 56.0% versus 70.4%, P =0.001) and at 90 days (modified Rankin Scale 0–2 in 70.6% versus 95.0%, P =0.001) also significantly improved. Compared with medical ward patients, outcome was significantly better in SW patients with fewer complications (10.9% versus 5.0%, P =0.013) and shorter length of stay (8.9±30.7 versus 5.4±16.1 days, P =0.05). Conclusions— Establishing a distinct SW is essential for achieving full benefits of stroke protocols implementation. SW patients have significantly fewer complications and better prognosis when compared with patients in medical wards.

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Do all ischemic stroke subtypes benefit from organized inpatient stroke care?

Abstract: A strong association between higher OCI and lower 30-day mortality was apparent in each ischemic stroke subtype. These data suggest that organized stroke care should be provided to stroke patients regardless of stroke subtype.

Cited by 55 publications

References 19 publications

Evaluation of the Possible Impact of a Care Network for Stroke and Transient Ischemic Attack on Rates of Recurrence

Evaluation of the Possible Impact of a Care Network for Stroke and Transient Ischemic Attack on Rates of Recurrence

Outcomes after ischemic stroke for hospitals with and without Joint Commission–certified primary stroke centers

Beneficial Effects of Implementing Stroke Protocols Require Establishment of a Geographically Distinct Unit

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