The contribution of a comprehensive stroke unit to the outcome of Chinese stroke patients.
BACKGROUND
There are significant differences in stroke patterns and risk factors for cerebrovascular disease between Chinese subjects and Caucasians. The outcome of stroke unit care in a Chinese population has not been described in the medical literature. The present study aims to evaluate the outcome of stroke unit care in Chinese subjects.


METHODS
By prospective comparative research, Chinese patients treated in the stroke unit were group-matched with those treated in the general medical ward by age, gender, premorbid functional status (by the Barthel Index), National Institute of Health Stroke Scale score, and stroke types. From April 2001 to April 2002, a total of 188 patients in the stroke unit group and 177 patients in the general ward group were recruited in the study. The main outcome measures included mortality at 28 and 120 days, and the length of inpatient stay.


RESULTS
Stroke unit care significantly reduced mortality of patients with acute stroke after 28 and 120 days. After 28 days, mortality was 3.3 percent and 17.2 percent for the stroke unit group and general ward group, respectively (p-value is equal to or less than 0.01); whereas after 120 days, mortality was 5.0 percent and 24.7 percent for the stroke unit group and general ward group, respectively (p-value is equal to or less than 0.001). The stroke unit care was demonstrated, by logistic regression analysis, to have contributed to the reduction of mortality at 120 days (p-value is 0.014). At 28 days, there was only a trend for stroke unit care to contribute to the reduction of mortality by logistic regression analysis (p-value is 0.067). By Kaplan-Meier survival curves (log rank statistic is 10.46, p-value is 0.001) and a Cox regression (hazard ratio 0.253, 95 percent confidence interval 0.085 to 0.754, p-value is 0.014), the stroke unit care was further found to reduce mortality significantly. The mean length of inpatient stay of the stroke unit group was 37.1 days, while that of the general medical ward group was 69.3 days (p-value is equal to or less than 0.001).


CONCLUSIONS
Chinese subjects receiving comprehensive stroke unit care are associated with less mortality and shorter length of hospital stay than those having conventional care in general medical wards.
Ko
K F
KF
Department of Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China. kokwaifu@yahoo.com.hk
Sheppard
L
L
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000208:ethnology; D005260:Female; D006723:Hong Kong; D006757:Hospital Units / Q000145:classification* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010362:Patients' Rooms / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D016896:Treatment Outcome