435 Stroke unit care effective

July 12, 2014

PEARLS 435, June 2014, written by Brian R McAvoy

Clinical question
How effective is organised inpatient (stroke unit) care for people following a stroke?

Bottom line
Compared with alternatives (care in general wards, mixed rehabilitation wards, mobile stroke teams), patients who received stroke unit care were more likely to be alive, independent and living at home 1 year after the stroke. The best results appeared to come from units based in a dedicated ward. There were no firm grounds for restricting access according to a person’s age, sex, stroke severity or type of stroke (ischaemic or haemorrhagic). There was no indication that stroke unit care resulted in a longer hospital stay.

Caveat
It was not clear how stroke units improved patient outcomes. This could have been due to greater staff expertise, better diagnostic procedures, better nursing care, early mobilisation, the prevention of complications or more effective rehabilitation procedures.¹

Context
Organised stroke unit care is a form of care provided in hospital by nurses, doctors and therapists who specialise in looking after stroke patients and work as a coordinated team.

Cochrane Systematic Review
Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Reviews, 2013, Issue 9. Art. No.: CD000197.DOI: 10.1002/14651858. CD000197.pub3. This review contains 28 studies involving 5855 participants.

1. Langhorne P et al. Stroke units: an evidence based approach. London: BMJ Books, 1998.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.