From the Foundation for Health Services Research, Central Hospital of
Akershus, Nordbyhagen, Norway.
Correspondence to Ole Morten Rønning, MD, Foundation for Health Services Research, Central Hospital of Akershus, 1474 Nordbyhagen, Norway. E-mail bguldvog{at}sia.pilot.akershus-f.kommune.no
Background and Purpose—The efficacy
of stroke units has been extensively examined. It is unknown, however,
whether the superiority of the stroke unit will remain after the
increased focus on stroke treatment in general medicine. This study of
patients admitted to the hospital early and with a short length of stay
determines the effect and identifies certain important components of a
stroke unit.
Methods—Five hundred fifty patients aged 60 years or older with
acute stroke were allocated by a quasi-randomized design to a stroke
unit or a general medical ward based on date of birth in the month.
Patients admitted within 24 hours of onset were enrolled. Outcomes
after 7 months were death, proportion needing long-term care, and
change in neurological and functional state assessed by the
Scandinavian Stroke Scale and Barthel Index.
Results—Seven months after admission there was a trend in favor
of the stroke unit in all outcome measures, but no significant
differences in clinical outcomes were found except for change in the
Scandinavian Stroke Scale score. Recurrent stroke during
hospitalization occurred more often in the general medical ward
(P=.03). The stroke unit was significantly more
aggressive in mobilization out of bed (P<.01) and use
of parenteral fluid (P<.0001), aspirin
(P<.0001), antipyretics (P<.0001), and
antibiotics (P<.0001).
Conclusions—Our study confirms the benefit of the stroke unit,
but the effects on the most reliable clinical outcomes were modest and
insignificant. Treatment in this stroke unit hastened recovery. More
aggressive rehabilitation and use of parenteral fluid, aspirin,
antipyretics, and antibiotics appeared in the stroke unit.
© 1998 American Heart Association, Inc.
Original Contributions
Stroke Unit Versus General Medical Wards, II: Neurological Deficits and Activities of Daily Living
A Quasi-Randomized Controlled Trial
Key Words: stroke management • stroke outcome • stroke units
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