Acute stroke unit care and early neurological deterioration in ischemic stroke.
OBJECTIVE
To evaluate the impact that monitored acute stroke unit care may have on the risk of early neurological deterioration (END), and 90-day mortality and mortality-disability.


METHODS
Non-randomized prospective study with consecutive patients with acute ischemic stroke (AIS) admitted to a conventional care stroke unit (CCSU), from May 2003 to April 2005, or to a monitored acute stroke unit (ASU) from May 2005 to April 2006. END was defined as an increase in the NIHSS score >or= 4 points in the first 72 hours after admission.


RESULTS
END was detected in 19.6% of patients (11.2% of patients admitted to the ASU and 23.8% to the CCSU; p<0.0001). Patients admitted to the ASU received more treatment with intravenous rtPa (13.5% versus 4.2%; p<0.0001), had a shorter length of stay (9.1 [11.0] d versus 13.1 [10.4] d; p<0.0001), lower 90-day mortality (10.2% versus 17.3%; p=0.02), and lower mortality-disability at 90-days (28.4% versus 40.2%; p=0.004) than those admitted to the CCSU. Multivariable analysis showed that ASU admission was a protector for END (OR: 0.37; 95% CI: 0.23-0.62). On admission, higher NIHSS (OR: 1.06; 95% CI: 1.03-1.10), higher glycaemia (OR: 1.003; 95% CI: 1.001-1.006), and higher systolic pressure (OR: 1.01; 95% CI: 1.002-1.017) were independent predictors of END.


CONCLUSIONS
END prevention by ASU care might be a key factor contributing to better outcome and decrease of length of stay in patients admitted to monitored stroke units.
Roquer
Jaume
J
Unitat d'Ictus, Servei de Neurologia, Hospital Universitari del Mar, Dept. de Medicina, Universitat Autònoma de Barcelona IMIM-Hospital del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain. 35826@imas.imim.es
Rodríguez-Campello
Ana
A
Gomis
Meritxell
M
Jiménez-Conde
Jordi
J
Cuadrado-Godia
Elisa
E
Vivanco
Rosa
R
Giralt
Eva
E
Sepúlveda
Maria
M
Pont-Sunyer
Claustre
C
Cucurella
Gracia
G
Ois
Angel
A
D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*