Comparison of stroke ward care versus mobile stroke teams in the Hungarian stroke database project.
Although previous studies have proved that both stroke wards and mobile stroke teams are considerably better than non-specialized stroke care, an unresolved debate in vascular neurology is whether or not stroke wards provide better outcomes in some specific cases to stroke victims. Our prospective, multicenter, cohort study compared dedicated stroke wards versus specialist stroke team care at general hospital wards in 11 centers nationwide for 8743 consecutive stroke events during 18 months. Twenty-eight-day case-fatality rate was 12.6% at stroke wards versus 15.2% at stroke teams for all patients (P = 0.002), and stroke ward care also predicted better outcome when analyzed with multivariate logistic regression model (odds ratio 1.701; confidence interval: 1.025-2.822). Case-fatality rates were not significantly different in patients with modified Rankin score > or = 2 (case-fatality rate: 17.8% vs. 20.3%; P = 0.163), and over 60 (case-fatality rate: 14.8% vs. 15.9%; P = 0.250), however these patients were more probably at home after 4 weeks when treated at stroke wards (56.1% vs. 50.6%; P = 0.03, and 69.5% vs. 64.5%; P = 0.004). In our study, stroke ward admission provided lower case-fatality rate below 60 and for those independent prior to their strokes, and lower institutionalization over 60 and amongst previously dependent patients, when compared with stroke teams.
Ováry
C
C
National Stroke Center, National Institute of Psychiatry and Neurology, Budapest, Hungary. ovary@interware.hu
Szegedi
N
N
May
Z
Z
Gubucz
I
I
Nagy
Z
Z
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000706:statistics & numerical data; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units / Q000706:statistics & numerical data; D010348:Patient Care Team; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome