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Meta-analyses of randomised trials of acute stroke treated in specialised stroke units have yielded convincing evidence of benefits in terms of reduced mortality rates, as compared with treatment in a general ward. However, no studies had been performed to ascertain whether the promising results could be reproduced in routine clinical practice. Accordingly, a comparison of routine care of acute stroke patients in stroke units (SUs) with that in general wards (GWs) was made on the basis of data for the 14,300 cases of acute stroke from 87 units in 80 Swedish hospitals registered in 1996 at the Swedish national stroke registry, the first of its kind in the world. Among patients capable of independent daily life and fully conscious at admission, the mortality rate was lower in the SU than in the GW subgroup, both at discharge from hospital and three months after the stroke event; and three months after stroke, a greater proportion of SU patients had been discharged to their homes, and a smaller proportion were in long-term care. However, no such subgroup differences were found among patients with impaired consciousness at admission. Thus, the promising results of the randomised trials of SU treatment would appear to be reproducible in routine clinical practice, though the beneficial effect is smaller in magnitude.