Stroke units in their natural habitat: can results of randomized trials be reproduced in routine clinical practice? Riks-Stroke Collaboration.
OBJECTIVE
Meta-analyses of randomized controlled trials of acute stroke care have shown care in stroke units (SUs) to be superior to that in conventional general medical, neurological, or geriatric wards, with reductions in early case fatality, functional outcome, and the need for long-term institutionalization. This study examined whether these results can be reproduced in clinical practice.


METHODS
A multicenter observational study of procedures and outcomes in acute stroke patients admitted to designated SUs or general medical or neurological wards (GWs), the study included patients of all ages with acute stroke excluding those with subarachnoid hemorrhage, who were entered into the Riks-Stroke (Swedish national quality assessment) database during 1996 (14 308 patients in 80 hospitals).


RESULTS
Patients admitted to SUs who had lived independently and who were fully conscious on admission to the hospital had a lower case fatality than those cared for in GWs (relative risk [RR] for death, 0.87; 95% confidence interval [CI], 0.79 to 0.96) and at 3 months (RR, 0.91; 95% CI, 0.85 to 0.98). A greater proportion of patients cared for in an SU could be discharged home (RR, 1.06; 95% CI, 1.03 to 1.10), and fewer were in long-term institutional care 3 months after the stroke (RR, 0.94; 95% CI, 0.89 to 0.99). No difference was seen in outcome in patients cared for in SUs or GWs if they had impaired consciousness on admission.


CONCLUSIONS
The improvement in outcomes after stroke care in SUs compared with care in GWs can be reproduced in the routine clinical setting, but the magnitude of the benefit appears smaller than that reported from meta-analyses.
Stegmayr
B
B
Department of Medicine, University Hospital, Umeå, Sweden. birgitta.stegmayr@medicin.umu.se
Asplund
K
K
Hulter-Asberg
K
K
Norrving
B
B
Peltonen
M
M
Terént
A
A
Wester
P O
PO
D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D002561:Cerebrovascular Disorders / Q000534:rehabilitation / Q000628:therapy*; D003243:Consciousness; D005260:Female; D005500:Follow-Up Studies; D006757:Hospital Units / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010343:Patient Admission; D011787:Quality of Health Care; D012042:Registries; D013548:Sweden; D016896:Treatment Outcome; D014474:Unconsciousness