Role of monitoring in management of acute ischemic stroke patients.
OBJECTIVE
Although several studies have demonstrated the effectiveness of specialist Stroke Unit (SU) care of stroke patients, there is still disagreement over how these units are best organized. We sought to clarify the role of continuous monitoring of physiological parameters in acute ischemic stroke.


METHODS
We conducted a prospective study of 268 first-ever ischemic stroke patients admitted to our Cerebrovascular Department and allocated, according to the availability of beds, to the SU or Cerebrovascular Unit (CU). Statistical analysis compared mortality and outcome at discharge, medical and neurological complications, and length of hospitalization in the 2 care settings.


RESULTS
Two hundred sixty-eight patients were enrolled. A good outcome at discharge, observed in 114 SU patients (85%) and 78 CU patients (58%) (odds ratio, 2.63; 95% CI, 1.4 to 4.8; P<0.02), was found, on multivariate analysis, to be significantly related to type of care (SU versus CU). A significantly greater proportion of SU patients showed adverse changes in monitored parameters, which required acute medical treatment (SU: 64%; CU: 19%; P<0.0001). The mean duration of these complications was significantly shorter in the SU patients (SU: 1.0 day; CU: 2.4 days; P<0.02), and the outcome in patients experiencing complications covered by the monitoring protocol was significantly better in the SU (66%) than in the CU (35%) group (P<0.0001).


CONCLUSIONS
Admission of acute stroke patients to a monitoring SU may positively influence their outcome at discharge. Confirmation of our findings in larger trials will indicate the need for a revision of the minimum requirements of SUs, with the addition of monitoring as a new requirement.
Cavallini
Anna
A
Cerebrovascular Department/Stroke Unit, . Mondino Foundation, Pavia, Italy. anna.cavallini@mondino.it
Micieli
Giuseppe
G
Marcheselli
Simona
S
Quaglini
Silvana
S
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001831:Body Temperature; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D004562:Electrocardiography; D004569:Electroencephalography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012119:Respiration; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*