Combination of acute stroke unit and short-term stroke ward with early supported discharge decreases mortality and complications after acute ischemic stroke.
BACKGROUND
The stroke unit has been established as a standard care for stroke. However, it has not been widely established in developing countries due to the lack of understanding and limited resources.


OBJECTIVE
To compare the complications and mortality of stroke patients admitted in the stroke unit and short-term ward with those admitted in the general medical ward.


METHODS
The authors prospectively collected data of acute stroke patients who were admitted after the set up of the stroke unit and stroke short-term ward in 2003, and compared with the data of those who were admitted in a general medical ward in 2001. All acute stroke patients who presented within seven days of the onset were admitted and those who had final diagnosis of ischemic stroke or transient ischemic attack (TIA) were studied. Patients in the stroke unit were taken care of by a multidisciplinary team approach under clinical guidelines and a care map. The short-term ward is a part of the general medical ward and stroke patients were treated by a multidisciplinary team followed by homecare treatment. The endpoints were mortality rate, neurological and medical complications during admissions, and the mean length of stay.


RESULTS
Seven hundred and ninety-four patients were studied. Three hundred and eighty-seven patients were admitted in 2001 and 407 patients in 2003. Among patients presented 2003, three hundred and one cases were treated in the acute stroke unit whereas 106 were admitted in the short-term ward. There was no difference in stroke risk factors and stroke subtypes between the two groups, except for dyslipidemia and cigarette smoking, which were more prevalent in patients admitted in 2003. Patients in the stroke unit and the short-term ward had significantly less mortality than those in the general medical ward (8.9 and 2.1%). Overall complications in the stroke unit and the short-term ward were 16.8%, compared to 26% of those admitted into the general medical ward. Significantly less brain edema, hemorrhagic infarction, urinary tract infection, pneumonia, and pressure sore were also observed. The length of hospital stay of the patients admitted in 2001 and 2003 was 11.26 and 8.09 days, respectively.


CONCLUSIONS
Combination of organized acute stroke unit and short-term ward with early supported discharge reduces the mortality and complications of ischemic stroke patients during admission as well as the length of stay when compared to the general medical ward. The present study reassures that the combination is useful for hospitals in developing countries, which have limited number of beds in their stroke units.
Suwanwela
Nijasri Charnnarong
NC
Neurological Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Rd, Bangkok 10330, Thailand. fmednsu@md2.md.chula.ac.th
Eusattasak
Nattapong
N
Phanthumchinda
Kammant
K
Piravej
Krisna
K
Locharoenkul
Chaichon
C
D000208:Acute Disease; D002545:Brain Ischemia / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000145:classification / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors