(Stroke. 1997;28:1861-1866.)
© 1997 American Heart Association, Inc.
Articles |
Stroke Unit Treatment
Long-term Effects
From the Department of Medicine, University Hospital of Trondheim (B.I., S.A.S., F.B., R.R.), and the Life Insurance Companies' Institute of Medical Statistics, Ullevaal Hospital, Oslo (L.L.H.), Norway.
Correspondence to Dr Bent Indredavik, The Stroke Unit, Department of Medicine, University Hospital of Trondheim, N-7006 Trondheim, Norway.
Background and Purpose We have previously shown that treatment in our combined acute and rehabilitation Stroke Unit improves outcome during the first year after onset of stroke compared with stroke patients treated in general wards. The aim of the present trial was to examine the long-term effects of the stroke unit care.
Methods In a randomized controlled trial, 110 patients with symptoms and signs of an acute stroke were allocated to the Stroke Unit and 110 to general wards. No significant differences existed in baseline characteristics between the two groups. The outcome after 5 years was measured by the proportion of patients at home, the proportion of patients in an institution, the mortality, and the functional state assessed by Barthel Index.
Results After 5 years, 38 (34.5%) of the patients randomized to the Stroke Unit and 20 (18.2%) of the patients randomized to the general wards were at home (P=.006). Sixty-five (59.1%) of the patients from the Stroke Unit and 78 (70.9%) of the patients from the general wards were dead (P=.041), while 7 (6.4%) and 12 (10.9%), respectively, were in an institution (eg, nursing home) (P=NS). Functional state was significantly better for patients treated in the Stroke Unit.
Conclusions For the first time it is shown that stroke unit care improves long-term survival and functional state and increases the proportion of patients able to live at home 5 years after the stroke. Combined acute and rehabilitation stroke units appear to be an effective way of organizing treatment for acute stroke patients.
Key Words: clinical trials • stroke management • stroke outcome • stroke unit
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