Survival of unselected stroke patients in a stroke unit compared with conventional care.
BACKGROUND
Recent meta-analyses have reported a beneficial effect of stroke units compared with traditional care, both on patient survival and on dependency after one year.


OBJECTIVE
To determine whether these results can be reproduced outside a clinical trial setting.


METHODS
A medium-sized general hospital.


METHODS
From 1993 to 1998, all patients aged >60 years with suspected acute stroke were allocated either to a stroke unit or general medical wards according to date of birth (day of the month). Patients were identified retrospectively, using a discharge diagnosis of ICD-9 codes 431, 434 and 436. We assessed 30-day and 1-year survival.


RESULTS
In the stroke unit, 926/1128 patients survived at 30 days, vs. 905/1141 in the general medical wards (p=0.08). Beyond the first 30 days, there was no difference in survival (p=0.27). Under Cox regression analysis, there was a 20% reduction in mortality in the stroke unit after 30 days compared with the general medical wards (RR 0.80, p=0.02) after adjusting for age, gender, stroke type and season of the year.


CONCLUSIONS
In this, the largest single-centre study to evaluate the survival benefit of a stroke unit, survival at 30 days was increased, although not significantly so. Survival at one year was unchanged.
Stavem
K
K
Department of Medicine and Foundation for Health Services Research (HELTEF), Central Hospital of Akershus, Nordbyhagen, Norway. knut.stavem@klinmed.uio.no
Rønning
O M
OM
D000208:Acute Disease; D000368:Aged; D005260:Female; D006757:Hospital Units; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D018579:Patient Selection; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate