(Stroke. 1999;30:709-714.)
© 1999 American Heart Association, Inc.
Original Contributions |
Stroke Units in Their Natural Habitat
Can Results of Randomized Trials Be Reproduced in Routine Clinical Practice?
From the Department of Medicine, University Hospital, Umeå (B.S., K.A., M.P.); Department of Medicine, Enköping Hospital (K.H.-Å.); Department of Medicine, University Hospital, Uppsala (A.T.); Department of Neurology, University Hospital, Lund (B.N.); and Swedish National Board of Health and Welfare, Stockholm, Sweden (P.O.W.).
Correspondence to Dr Birgitta Stegmayr, Department of Medicine, University Hospital, S-901 85 UMEÅ, Sweden. E-mail birgitta.stegmayr{at}medicin.umu.se
Background and Purpose—Meta-analyses of randomized controlled trials of acute stroke care have shown care in stroke units (SUs) to be superior to that in conventional general medical, neurological, or geriatric wards, with reductions in early case fatality, functional outcome, and the need for long-term institutionalization. This study examined whether these results can be reproduced in clinical practice.
Methods—A multicenter observational study of procedures and outcomes in acute stroke patients admitted to designated SUs or general medical or neurological wards (GWs), the study included patients of all ages with acute stroke excluding those with subarachnoid hemorrhage, who were entered into the Riks-Stroke (Swedish national quality assessment) database during 1996 (14 308 patients in 80 hospitals).
Results—Patients admitted to SUs who had lived independently and who were fully conscious on admission to the hospital had a lower case fatality than those cared for in GWs (relative risk [RR] for death, 0.87; 95% confidence interval [CI], 0.79 to 0.96) and at 3 months (RR, 0.91; 95% CI, 0.85 to 0.98). A greater proportion of patients cared for in an SU could be discharged home (RR, 1.06; 95% CI, 1.03 to 1.10), and fewer were in long-term institutional care 3 months after the stroke (RR, 0.94; 95% CI, 0.89 to 0.99). No difference was seen in outcome in patients cared for in SUs or GWs if they had impaired consciousness on admission.
Conclusions—The improvement in outcomes after stroke care in SUs compared with care in GWs can be reproduced in the routine clinical setting, but the magnitude of the benefit appears smaller than that reported from meta-analyses.
Key Words: randomized controlled trials • stroke outcome • stroke units • stroke, acute
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|
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|
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|
|
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|
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|
|
|
|
|
|
Bibliography Scand J Public Health, October 1, 2003; 31(5): 85 - 91. [PDF]
|
|
|
|
|
|
C. Sarti, B. Stegmayr, H. Tolonen, M. Mahonen, J. Tuomilehto, and K. Asplund Are Changes in Mortality From Stroke Caused by Changes in Stroke Event Rates or Case Fatality?: Results From the WHO MONICA Project Stroke, August 1, 2003; 34(8): 1833 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
W. A. Wattigney, J. B. Croft, G. A. Mensah, M. J. Alberts, T. J. Shephard, P. B. Gorelick, D. S. Nilasena, D. C. Hess, M. D. Walker, D. F. Hanley Jr, et al. Establishing Data Elements for the Paul Coverdell National Acute Stroke Registry: Part 1: Proceedings of an Expert Panel Stroke, January 1, 2003; 34(1): 151 - 156. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Phillips, G. A. Eskes, G. J. Gubitz, and o. Elizabeth II Description and evaluation of an acute stroke unit Can. Med. Assoc. J., September 1, 2002; 167(6): 655 - 660. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Hallstrom, B. Norrving, and A. Lindgren Stroke in Lund-Orup, Sweden: Improved Long-Term Survival Among Elderly Stroke Patients Stroke, June 1, 2002; 33(6): 1624 - 1629. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Stavem and O.M. Ronning Survival of unselected stroke patients in a stroke unit compared with conventional care QJM, March 1, 2002; 95(3): 143 - 152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.-L. Glader, B. Stegmayr, L. Johansson, K. Hulter-Asberg, and P. O. Wester Differences in Long-Term Outcome Between Patients Treated in Stroke Units and in General Wards: A 2-Year Follow-Up of Stroke Patients in Sweden Stroke, September 1, 2001; 32(9): 2124 - 2130. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Weir and M. S. Dennis Towards a National System for Monitoring the Quality of Hospital-Based Stroke Services Stroke, June 1, 2001; 32(6): 1415 - 1421. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O G Nilsson, A Lindgren, N Stahl, L Brandt, and H Saveland Incidence of intracerebral and subarachnoid haemorrhage in southern Sweden J. Neurol. Neurosurg. Psychiatry, November 1, 2000; 69(5): 601 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Rundek, H. Mast, A. Hartmann, B. Boden-Albala, L. Lennihan, I.-F. Lin, M. C. Paik, and R. L. Sacco Predictors of resource use after acute hospitalization: The Northern Manhattan Stroke Study Neurology, October 24, 2000; 55(8): 1180 - 1187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Brott and J. Bogousslavsky Treatment of Acute Ischemic Stroke N. Engl. J. Med., September 7, 2000; 343(10): 710 - 722. [Full Text] [PDF]
|
|
|
|
|
|
S. Sinha and E.A. Warburton The evolution of stroke units--towards a more intensive approach? QJM, September 1, 2000; 93(9): 633 - 638. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
 G. Gubitz and P. Sandercock Extracts from "Clinical Evidence": Acute ischaemic stroke BMJ, March 11, 2000; 320(7236): 692 - 696. [Full Text]
|
|
|
|
|
|
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|
|