[Stroke unit. An important addition to stroke treatment.].
In Iceland, about 770 strokes can be estimated to occur annually. Until recently no treatment had been shown to be effective for acute and subacute strokes. This may have led to therapeutical nihilism and inconsistency in treatment. In 1995, however, t-PA was shown to improve functional outcome when given within three hours of stroke onset. The effectiveness of organized stroke care (stroke unit) has been controversial for 30 years. It is only in 1992 that its effects has become apparent with improved research design and systemic evaluation of the available data. Stroke unit treatment reduces mortality and improves functional outcome with more patients being discharged to home. All groups of patients benefit from this form of treatment, and there is no ground for excluding patients because of gender, age or stroke severity. Good results are obtained both in dedicated as well as mixed assessment/rehabilitation stroke units. Acute (<7 days) or delayed (>7 days) admission to a stroke unit does not affect outcome, however, the duration of treatment must exceed several weeks. The effectiveness of the stroke unit appears to be due to the novel approach of treatment (multi-disciplinary team approach). The departmental setting in which it takes place (within the department of neurology, medicine, geriatric medicine or rehabilitation) has no influence on outcome. Stroke unit treatment is most reliable when delivered in a dedicated geographic location rather than as a consultative service. The cost of acute hospitalization/rehabilitation on such unit is probably not increased, since hospital/ rehabilitation stay seems to be the same or slightly less than with conventional care. Long term cost after such treatment is reduced, since fewer patients need long term placement.
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Sigurdsson