Stroke Unit Versus General Medical Wards, II: Neurological Deficits and Activities of Daily Living

126

Background and Purpose-Stroke unit treatment is effective in reducing death and dependency after stroke but is not available in many, particularly rural, areas. The implementation of a stroke network with telemedicine support was associated with improved outcome at 3 months. We report follow-up results at 12 and 30 months after acute stroke. Methods-Telemedical Project for Integrative Stroke Care (TEMPiS) consists of the set-up of specialized local stroke wards, continuous medical education, and telemedical consultation for patients with acute stroke by 2 stroke centers. In a prospective, nonrandomized, intervention study, 5 community hospitals participating in the network were compared with 5 matched control hospitals without specialized stroke facilities or telemedical support. All patients with consecutive ischemic or hemorrhagic stroke admitted between July 2003 and March 2005 were evaluated. Outcome "death and dependency" was defined by death, institutional care, or disability (Barthel index Ͻ60 or Rankin scale Ͼ3). Results-We followed-up 3060 patients (1938 in TEMPiS and 1122 in control hospitals

Section: Discussionmentioning

confidence: 89%

Long-Term Effects of Specialized Stroke Care With Telemedicine Support in Community Hospitals on Behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS)

Audebert

Schultes

Tietz

et al. 2009

126

“…[879][880][881][882][883][884][885][886][887][888][889][890][891][892] The positive effects persist for years. The benefits from treatment in a stroke unit are comparable to the effects achieved with intravenous administration of rtPA.…”

Section: Specialized Stroke Care Unitsmentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

5,372

1,801

Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

“…Key features of stroke-unit care are a dedicated multidisciplinary team, early rehabilitation, prevention and adequate treatment of complications, and involvement of both patient and relatives in the rehabilitation process. [1][2][3][4][5][6] From animal experiments and human observational studies, a number of factors have been identified that appear to aggravate initial brain damage and worsen outcome after ischemic stroke. Besides hyperglycemia, these include elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias.…”

mentioning

confidence: 99%

Admitting Acute Ischemic Stroke Patients to a Stroke Care Monitoring Unit Versus a Conventional Stroke Unit

Sulter¹,

Elting²,

Langedijk³

et al. 2003

158

101

Background and Purpose-Pathophysiological considerations and observational studies indicate that elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias in the acute phase of ischemic stroke may aggravate brain damage and worsen outcome. Methods-Both units were organized with the same standard care and multidisciplinary approach to nursing and rehabilitation. A blinded observer assessed functional outcome at 3 months with the modified Rankin scale (mRS) and Barthel Index (BI). End points were (1) poor outcome, defined as either mRS Ն4 or BI Ͻ60 or the need for institutional care and (2) mortality. Results-Fifty-four patients meeting the inclusion criteria were randomized. The groups were well matched for baseline characteristics, stroke subtype, stroke severity, vascular risk factors, and prognostic factors.