Impact of a stroke unit on length of hospital stay and in-hospital case fatality.
OBJECTIVE
Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward.


METHODS
A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index.


RESULTS
Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30% (P<0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care.


CONCLUSIONS
We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.
Zhu
Hai Feng
HF
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Rm 1242A, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
Newcommon
Nancy N
NN
Cooper
Mary Elizabeth
ME
Green
Teri L
TL
Seal
Barbara
B
Klein
Gary
G
Weir
Nicolas U
NU
Coutts
Shelagh B
SB
Watson
Tim
T
Barber
Philip A
PA
Demchuk
Andrew M
AM
Hill
Michael D
MD
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D015331:Cohort Studies; D015897:Comorbidity; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data* / Q000639:trends*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009313:National Health Programs / Q000706:statistics & numerical data / Q000639:trends; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D017678:Sex Distribution; D020521:Stroke / Q000401:mortality* / Q000451:nursing / Q000628:therapy*; D016896:Treatment Outcome