Stroke-unit care for acute stroke patients

Objective Cochrane systematic review demonstrated the benefit of stroke-unit care for sub-acute stroke patients. Our aim was to determine whether acute stroke patients admitted into stroke units have a better long-term outcome than those treated in conventional wards. Methods The study is an observational follow-up study on 11 572 acute stroke patients hospitalised within 48 hours of the onset of symptoms from 2002 to 2004 in Italy, comparing the long-term outcome of patients cared for in stroke units (n=4936) with those cared for in conventional wards (6636). Patients were identified retrospectively from discharge records from 260 Italian hospitals in seven Italian regions. The stroke unit was defined as a discrete area of dedicated beds and with a multidisciplinary dedicated staff. The primary outcome was mortality or disability (Rankin score greater than two), assessed prospectively by independent, masked assessors 2 years after admission. Results Patients who received stroke-unit care were less likely to be dead or disabled than the controls by the end of follow-up (odds ratio 0·81, 95% CI 0·72–0·91; p=0·0001). The possible benefit of stroke-unit care was also evident for in-hospital, long-term mortality, and for the likelihood of not being at home 2 years after hospital discharge. The potential benefit was significant across all age ranges and clinical characteristics, except for unconsciousness. No specific elements of setting, organisation, or process of care were associated with outcome. Discussion: We provided evidence that admission into a stroke-unit ward with dedicated beds and staff within 48 hours of onset should be recommended for all patients with acute stroke. At present, there is no indication that any further element of care is of benefit.