title: Acute stroke unit care and early neurological deterioration in ischemic stroke.
abstract: 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.
authors: 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
authors: Jaume
authors: J
authors: Roquer
authors: Ana
authors: A
authors: Rodríguez-Campello
authors: Meritxell
authors: M
authors: Gomis
authors: Jordi
authors: J
authors: Jiménez-Conde
authors: Elisa
authors: E
authors: Cuadrado-Godia
authors: Rosa
authors: R
authors: Vivanco
authors: Eva
authors: E
authors: Giralt
authors: Maria
authors: M
authors: Sepúlveda
authors: Claustre
authors: C
authors: Pont-Sunyer
authors: Gracia
authors: G
authors: Cucurella
authors: Angel
authors: A
authors: Ois
mesh_terms: 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*