Organised inpatient (stroke unit) care for stroke: network meta-analysis

Langhorne, Peter; Ramachandra, Samantha

doi:10.1002/14651858.cd000197.pub4

Cited by 219 publications

(267 citation statements)

References 84 publications

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“…In our study, the time to a first medical evaluation in <1 h occurred in 75% of patients, but only 25% arrived to our referral centers in <3 h. This salient discrepancy may reflect that recognition of stroke symptoms by witnesses or the patients is usually opportune, regardless the stroke type, and that in the majority of cases, they are acting rapidly seeking for medical evaluation in <1 h, but that this first medical assessment occurs in a medical center that is not prepared to treat stroke patients, ultimately referring the patients to a dedicated center, and thus, wasting critical time to establish appropriate medical care. This unfortunate fact may be due to a reduced sensitivity of the medical staff or an inadequate hospital infrastructure 11,18,19 . In the ICH and SAH cases, we detected a lower final onset-to-door time, probably because the clinical presentation of these stroke types is usually perceived as more severe 11,12 .…”

Section: Discussionmentioning

confidence: 99%

Reliability of Bystander Recognition of Clinical Features in Pre-Hospital Classification of Acute Cerebrovascular Syndromes: Preliminary Findings

Chiquete¹,

Sandoval-Rodríguez²,

García‐Grimshaw³

et al. 2021

RIC

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Background: The recognition of stroke symptoms by patients or bystanders directly affects the outcomes of patients with acute cerebrovascular disease. Objective: The objective of the study was to assess the predictive value of the medical history and clinical features recognized by the patients' bystanders to classify neurovascular syndromes in pre-hospital settings. Methods: We included 150 stroke patients of two Mexican referral centers: 50 with acute ischemic stroke (AIS), 50 with intracerebral hemorrhage (ICH), and 50 with subarachnoid hemorrhage (SAH). The performance of clinical prediction rules (CPR) to identify the stroke types was evaluated with features recognized by the patients' bystanders before hospital arrival. The impact of CPRs on early arrival and in-hospital mortality was also analyzed. Results: Overall, 72% of the patients had previous medical evaluations in other centers before final referral to our hospitals, and therefore, only 45% had a final onsetto-door time <6 h, even when the first medical assessment had occurred in ≤1 h in 75% of cases. Clinical features noticed by the patients' bystanders had low positive predictive values (PPV) for any stroke type. The CPR "language or speech disorder + focal motor deficit" had 93% sensitivity and a negative predictive value (NPV) of 84% to distinguish AIS. In SAH, headache alone showed a sensitivity of 84% and NPV of 97%. No CPR had an adequate performance on ICH. CPRs were not associated with final onset-to-door time. Altered consciousness, age ≥65 years, indirect arrival with stops before final referral, and atrial fibrillation increased in-hospital mortality. Conclusion: Clinical features referred by the witness of a neurovascular emergency have limited PPV, but adequate NPV in ruling-out AIS and SAH among stroke types. The use of CPRs had no impact on onset-to-door time or in-hospital mortality when the final arrival to a third-level center occurs with previous medical referrals. (REV INVEST CLIN. [AHEAD OF PRINT]

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Section: Discussionmentioning

confidence: 99%

Reliability of Bystander Recognition of Clinical Features in Pre-Hospital Classification of Acute Cerebrovascular Syndromes: Preliminary Findings

Chiquete¹,

Sandoval-Rodríguez²,

García‐Grimshaw³

et al. 2021

RIC

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“…As stroke services develop, it is important to evaluate variations on the dedicated stroke ward model, the main alternatives being to have a stroke unit nested within a mixed rehabilitation ward, or to have a peripatetic stroke team who do not have a fixed ward base. However, the 'nested' model appears to have fallen out of favour, with studies in this review 3 dating from 1962 to 1995. The rise of the 'dedicated stroke unit' model is more recent, represented by studies from 1980 to 2014.…”

Section: Author's Commentarymentioning

confidence: 96%

Multidisciplinary inpatient stroke unit care reduces death and dependency at discharge, with greatest benefits from care on a discrete stroke ward

Gibson

2020

Evid Based Nurs

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“…19 All patients admitted to a Norwegian hospital with the diagnosis of stroke receive evidence-based stroke treatment according to the recommendations during their initial hospital stay. 21 This study was conducted in accordance with the Declaration of Helsinki.…”

Section: Study Design and Settingmentioning

confidence: 99%

<p>The Risk of Selection Bias in a Clinical Multi-Center Cohort Study. Results from the Norwegian Cognitive Impairment After Stroke (Nor-COAST) Study</p>

Kuvås¹,

Saltvedt²,

Aam³

et al. 2020

CLEP

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Purpose: The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study aimed to estimate the prevalence and incidence of neurocognitive disorder in an unselected stroke cohort. The aim of the present study was to investigate whether selection bias occurred by comparing baseline characteristics from participants with non-participants in Nor-COAST. Patients and Methods: Nor-COAST is a prospective cohort multi-center study, recruiting participants from five Norwegian hospitals. Patients with the diagnosis of acute stroke were screened for inclusion. Baseline data from the participants recruited between May 2015 and March 2017 were compared to corresponding data from those not participating in Nor-COAST but registered in the Norwegian Stroke Registry. Regression analysis was used to assess whether age, stroke severity, sex and stroke subtype were independently associated with inclusion in the study. Results: Out of 2505 available patients, 815 (32.5%) were included in Nor-COAST. There were no differences between participants and non-participants with respect to age (mean (SD) age 73.5 (11.7) versus 74.2 (14.5) years) or sex (44.8% versus 46.9% women). A significantly larger proportion of the participants were independent prior to stroke (87% versus 78%), had mild strokes (69% versus 55%) and suffered from cerebral infarction (90% versus 84%). The regression analysis showed decreased odds ratio (OR) of being included for those with higher degree of pre-stroke dependency (OR 0.895, 95% CI 0.825 to 0.971, p=0.007) and a more severe stroke (OR 0.952, 95% CI 0.939 to 0.966, p<0.001). Conclusion: The participants in Nor-COAST had a better pre-stroke health condition and milder strokes compared to non-participants. However, the participants should be regarded as representative of the majority of the stroke population which suffers from mild strokes. Nevertheless, baseline information for non-participants should be available also in future clinical studies to make it easier to identify which part of the stroke population the results can be generalized to.

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Organised inpatient (stroke unit) care for stroke: network meta-analysis

Cited by 219 publications

References 84 publications

Reliability of Bystander Recognition of Clinical Features in Pre-Hospital Classification of Acute Cerebrovascular Syndromes: Preliminary Findings

Reliability of Bystander Recognition of Clinical Features in Pre-Hospital Classification of Acute Cerebrovascular Syndromes: Preliminary Findings

Multidisciplinary inpatient stroke unit care reduces death and dependency at discharge, with greatest benefits from care on a discrete stroke ward

<p>The Risk of Selection Bias in a Clinical Multi-Center Cohort Study. Results from the Norwegian Cognitive Impairment After Stroke (Nor-COAST) Study</p>

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