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Stroke Units: The Standard Of Care?
A DGReview of :"Alternative strategies for stroke care: a prospective randomised controlled trial"
Lancet
09/14/2000
By Mark Greener
In-hospital stroke units reduce mortality, institutionalisation and dependence to a greater extent than a specialist team attached to a general ward or specialist domiciliary care, a UK-based study suggests.
A growing body of evidence suggests that organised specialist care can improve outcomes among stroke patients. The ideal service structure, however, remains unclear.
Against this background, UK researchers compared outcomes in 457 patients suffering from acute strokes who were managed in a stroke unit, general wards with stroke team support and domiciliary care.
The cohort had an average age of 76 years and was 48 per cent female. Patients were randomly assigned to one of the three pathways within 72 hours of suffering their stroke. The authors assessed outcome after three, six and 12 months.
Thirty-four per cent of patients who were managed with domiciliary care were admitted to hospital. After a year, the risk of either death or institutionalisation was lower among patients cared for on a stroke unit (14 per cent) than among those receiving care from a stroke team (30 per cent) or domiciliary care (24 per cent).
Most of the statistically significant benefits associated with the stroke unit, compared to the other two strategies, arose because of the mortality reduction. Furthermore, the proportion of patients alive without severe disability after one year was higher on the stroke unit compared with stroke team or domiciliary care (85, 66 and 71 per cent respectively).
The authors add that the stroke unit's benefits were also present between three and six months after stroke.
The authors conclude that stroke units reduce mortality, institutionalisation and dependence to a greater extent than specialist teams either in hospital or in patients' homes.
"Alternative strategies for stroke care: a prospective randomised controlled trial"
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