(Stroke. 2001;32:871.)
© 2001 American Heart Association, Inc.
Original Contributions |
Should Mild or Moderate Stroke Patients Be Admitted to an Intensive Care Unit?
Presented in part at the 124th American Neurological Association meeting, Seattle, Wash, October 12, 1999.
From the Department of Neurology, UT–Houston Medical School, Houston, Tex, and Ochsner Clinic, New Orleans, La (R.A.F.).
Correspondence to James Grotta, MD, UT-STAT Stroke Treatment Team, Department of Neurology, UT–Houston Medical School, 6431 Fannin, MSB 7.044, Houston, TX 70330. E-mail james.c.grotta{at}uth.tmc.edu
Background and Purpose—Inhospital placement of patients with mild (National Institutes of Health Stroke Scale [NIHSS] score <8) or moderate (NIHSS 8 through 16) acute strokes is variable. We assessed the outcome of such patients based on intensive care unit (ICU) versus general ward placement.
Methods—We reviewed 138 consecutive patients admitted within 24 hours of stroke onset to 2 physically adjacent hospitals with different admitting practices. Outcome measures included complication rates, discharge Rankin scale score, hospital discharge placement, costs, and length of stay (LOS).
Results—Hospital A, a 626-bed university-affiliated hospital, admitted 43% of mild and moderate strokes (MMS) to an ICU (26% of mild, 74% of moderate), whereas hospital B, a 618-bed community facility, admitted 18% of MMS to an ICU (3% of mild, 45% of moderate; P<0.004). There were no significant differences in outcomes between the 2 hospitals. Analysis of only patients admitted to hospital A, and of all patients, demonstrated that mild stroke patients admitted to the general ward had fewer complications and more favorable discharge Rankin scale scores than similar patients admitted to an ICU. There was no statistically significant difference in LOS, but total room costs for a patient admitted first to the ICU averaged $15 270 versus $3638 for admission directly to the ward.
Conclusions—While limited by the retrospective nature of our study, routinely admitting acute MMS patients to an ICU provides no cost or outcomes benefits.
Key Words: costs and cost analysis • stroke • stroke management • stroke outcome • triage
This article has been cited by other articles:
 |
|
 |
|
  J. Bernhardt, N. Chitravas, I. L. Meslo, A. G. Thrift, and B. Indredavik Not All Stroke Units Are the Same: A Comparison of Physical Activity Patterns in Melbourne, Australia, and Trondheim, Norway Stroke, July 1, 2008; 39(7): 2059 - 2065. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Indredavik, G. Rohweder, E. Naalsund, and S. Lydersen Medical Complications in a Comprehensive Stroke Unit and an Early Supported Discharge Service Stroke, February 1, 2008; 39(2): 414 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bernhardt, H. Dewey, A. Thrift, J. Collier, and G. Donnan A Very Early Rehabilitation Trial for Stroke (AVERT): Phase II Safety and Feasibility Stroke, February 1, 2008; 39(2): 390 - 396. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Juttler, S. Schwab, P. Schmiedek, A. Unterberg, M. Hennerici, J. Woitzik, S. Witte, E. Jenetzky, W. Hacke, and for the DESTINY Study Group Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): A Randomized, Controlled Trial Stroke, September 1, 2007; 38(9): 2518 - 2525. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Onukwugha and C. D. Mullins Racial Differences in Hospital Discharge Disposition among Stroke Patients in Maryland Med Decis Making, May 1, 2007; 27(3): 233 - 242. [Abstract] [PDF]
|
|
|
|
|
|
J. Bernhardt, H. Dewey, A. Thrift, and G. Donnan Inactive and Alone: Physical Activity Within the First 14 Days of Acute Stroke Unit Care Stroke, April 1, 2004; 35(4): 1005 - 1009. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Yoneda, T. Uehara, H. Yamasaki, Y. Kita, M. Tabuchi, and E. Mori Hospital-Based Study of the Care and Cost of Acute Ischemic Stroke in Japan Stroke, March 1, 2003; 34(3): 718 - 724. [Abstract] [Full Text] [PDF]
|
|