Do all age groups benefit from organized inpatient stroke care?
OBJECTIVE
Organized inpatient stroke care consists of a multidisciplinary approach aimed at improving stroke outcomes. It is unclear whether elderly individuals benefit from these interventions to the same extent as younger patients. We sought to determine whether the reduction in mortality or institutionalization seen with organized stroke care was similar across all age groups.


METHODS
This was a case-cohort study of patients with acute ischemic stroke seen between July 2003 and March 2005 and captured in the Registry of the Canadian Stroke Network. After stratifying by age category, we assessed for evidence of effect modification by age on the reduction in stroke fatality associated with stroke unit/organized care.


RESULTS
Among 3631 patients with ischemic stroke, stroke case-fatality at 30 days was lower for patients admitted to a stroke unit compared with those admitted to general medical wards (10.2% versus 14.8%; P<0.0001 with an absolute risk reduction=4.6%, number needed to treat=22). All age groups achieved a similar benefit of stroke unit care versus general medical ward care (absolute risk reduction for 30-day stroke fatality was 4.5% for <60 years; 3.4% for 60 to 69 years; 5.3% for 70 to 79 years; and 5.5% for those >80 years). Increasing levels of organized care were associated with lower stroke fatality or institutionalization. The beneficial effect of stroke units/organized care on survival was seen even after adjustment for multiple prognostic factors and after excluding patients on palliative approach. There was no evidence of effect modification by age in any analyses.


CONCLUSIONS
Stroke units and organized inpatient care reduce death or institutionalization with the same magnitude of effect across all age groups.
Saposnik
Gustavo
G
Stroke Research Unit, Division of Neurology, Department of Medicine, Stroke Outcome Research Canada, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Kapral
Moira K
MK
Coutts
Shelagh B
SB
Fang
Jiming
J
Demchuk
Andrew M
AM
Hill
Michael D
MD
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality / Q000451:nursing / Q000534:rehabilitation; D002170:Canada; D016022:Case-Control Studies; D015331:Cohort Studies; D017281:Cost of Illness; D004632:Emergency Medical Services; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007326:Institutionalization; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000706:statistics & numerical data* / Q000639:trends; D011787:Quality of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D040242:Risk Reduction Behavior; D020521:Stroke / Q000401:mortality* / Q000451:nursing / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome