Patients with acute stroke who receive stroke-unit care less likely to die

Patients with acute stroke who receive stroke-unit care are less likely to die or become disabled than patients treated in a conventional hospital ward, according to an observational follow-up study published in this week's issue of The Lancet.

Previous studies have shown that, compared with conventional care, stroke units are associated with better patient outcomes. However, it is unclear whether such management is applicable to everyday clinical practice.

To assess whether stroke units are effective in routine clinical practice, Livia Candelise (Department of Neurological Sciences, University of the Studies of Milan, Italy) and colleagues did an observational study of over 11 000 acute stroke patients admitted within 48 hours of stroke onset to a stroke unit or a conventional ward in hospitals in seven Italian regions between 2000 and 2004. Compared with treatment in a conventional ward, stroke-unit care was associated with around a 20% reduced risk of death or disability 2 years after discharge. The benefit of stroke-unit care was significant for all age ranges and clinical characteristics. Thus stroke-unit care provided in the acute phase of the disease could reduce in-hospital mortality and also increase the proportion of patients living independently about 2 years after discharge.

The authors conclude: "This study, which used a broad but reliable definition of stroke-unit models on the basis of the use of beds and staff dedicated exclusively to stroke patients, indicates that, provided admission occurs within 48 hours of onset, patients with acute stroke should be treated in stroke-unit wards with dedicated beds and staff, irrespective of age. . .This simple organisation of services is easy to implement, with great benefit in terms of reduced mortality and disability."