http://stroke.ahajournals.org/content/28/11/2139.full
- Correspondence to P. Langhorne, PhD, MRCP, Academic Section of Geriatric Medicine, 3rd Floor, Center Block, Royal Infirmary, Glasgow G4 0SF, Scotland. E-mail P.Langhorne@clinmed.gla.ac.uk
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.(This conclusion is not supportable from the data given)
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