Randomized controlled study of stroke unit care versus stroke team care in different stroke subtypes.
OBJECTIVE
The benefits of stroke unit management may vary according to stroke subtype. A post hoc analysis of the influence of stroke subtype on stroke unit effectiveness was undertaken by using prospective data collected in a randomized controlled trial.


METHODS
Two hundred sixty-seven patients with moderately severe ischemic stroke (164 with large-vessel infarcts and 103 with lacunar infarcts) were randomly allocated to treatment in stroke units or in general medical wards with specialist stroke team support. Mortality, institutionalization, neurological, functional, and quality-of-life scores and resource use were assessed at 3 and again at 12 months after stroke onset. An intention-to-treat analysis was undertaken, and logistic regression was used to evaluate the independent effect of stroke unit intervention.


RESULTS
Stroke team-supported management was associated with higher mortality (odds ratio [OR] 4.9, 95% CI 1.3 to 18.6) and higher mortality or institutionalization (OR 2.9, 95% CI 1.1 to 7.4) at 3 months (OR 3.6, 95% CI 1.5 to 8.7) and at 1 year (OR 2.8, 95% CI 1.3 to 6.2) in patients with large-vessel infarcts. In contrast, there were no significant differences in outcome in patients with lacunar strokes managed in the stroke unit or by the stroke team. In patients with lacunar strokes, stroke unit care was associated with a longer length of hospital stay (18 versus 13.5 days for stroke unit care versus stroke team care, respectively; P<0.01) and significantly greater use of therapy.


CONCLUSIONS
Stroke units improve the outcome in patients with large-vessel infarcts but not in those with lacunar syndromes. For lacunar strokes, stroke unit management may be associated with higher initial health costs for equivalent benefit.
Evans
Andrew
A
Department of Medicine, Guy's, King's, and St Thomas's School of Medicine, London, UK.
Harraf
Farzaneh
F
Donaldson
Nora
N
Kalra
Lalit
L
D000368:Aged; D005260:Female; D015276:Health Care Rationing / Q000706:statistics & numerical data; D006302:Health Services Research; D006699:Home Care Services / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006757:Hospital Units / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000191:economics / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000191:economics / Q000706:statistics & numerical data*; D011788:Quality of Life; D012720:Severity of Illness Index; D020521:Stroke / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology