1. How Do Stroke Units Improve Patient Outcomes?
- Author
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Martin Dennis, Heikki Palomäki, Rainer Fogelholm, Juhani Sivenius, T Strand, M Garraway, S WoodDauphinee, D Deleo, M Ilmavirta, Avril Drummond, Charles Warlow, Lalit Kalra, Jim Slattery, H Fraser, B.O. Williams, P. Berman, G. Hankey, Christian Blomstrand, Nadina B. Lincoln, A Svensson, Kjell Asplund, Richard Stevens, Lars Wilhelmsen, Peter Langhorne, Terttu Erilä, Carl Counsell, Elisabeth Hamrin, Bent Indredavik, Markku Kaste, and Helen Rodgers
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,Rehabilitation ,business.industry ,medicine.medical_treatment ,Stroke units ,Stroke unit care ,Outcome (game theory) ,law.invention ,Randomized controlled trial ,law ,Meta-analysis ,Physical therapy ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose We sought to clarify the way in which organized inpatient (stroke unit) care can produce reductions in case fatality and in the need for institutional care after stroke. Methods We performed a secondary analysis of a collaborative systematic review of all randomized trials that compared organized inpatient (stroke unit) care with contemporary conventional care. Nineteen trials were included, of which 18 (3246 patients) could provide outcome data on death, place of residence, and final functional outcome. Data were less complete (but always available for at least 12 trials; 1611 patients) for subgroup analyses examining timing and cause of death and outcomes in patients with different levels of severity of initial stroke. Results The reduction in case fatality of patients managed in a stroke unit setting developed between 1 and 4 weeks after the index stroke. The reduction in the odds of death was evident across all causes of death and most marked for those deaths considered to be secondary to immobility. However, data were insufficient to permit a firm conclusion. The relative increase in the number of patients discharged home from stroke units as opposed to conventional care was largely attributable to an increase in the number of patients returning home physically independent. Across the range of stroke severity, stroke unit care was associated with nonsignificant increases in the number of patients regaining independence. Conclusions Within the limitations of the available data, we conclude that organized inpatient stroke unit care probably benefits a wide range of stroke patients in a variety of different ways, ie, reducing death from secondary complications of stroke and reducing the need for institutional care through a reduction in disability.
- Published
- 1997