Semi-intensive stroke unit versus conventional care in acute ischemic stroke or TIA--a prospective study in Germany.
German Society of Neurology's stroke-unit concept includes a specialized stroke-unit team and advanced monitoring facilities in the early phase of stroke. Our aim was to evaluate the effectiveness of this semi-intensive stroke-unit (SI-SU) concept as compared with conventional care (CC) for patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Over a 20-month period starting in March 2001, 755 patients with AIS or TIA were treated under SI-SU (n=393) or CC (n=362) conditions within an observational study. All patients were admitted within 24h after symptom onset. Patients' outcomes were assessed after 1 year of follow-up, considering concept of care, patients' clinical characteristics, and comorbid conditions. The CC patients were older and had a greater frequency of atrial fibrillation. 1 year after ischemia, 715 patients (94.7%) could be reinvestigated. Mortality and disability (mRS>2) were lower in the SI-SU group compared with the CC group (15.6% vs. 27.0%, P<.05; 33.9% vs. 39.8%, P=.16, respectively). In multivariate analysis, AIS patients (n=453) treated under SI-SU had significantly lower 1-year mortality and disability compared with the CC-treated patients (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.27-0.83 and OR: 0.44, 95% CI: 0.22-0.87; respectively). For TIA patients, (n=262) SI-SU care showed no significant effect in any outcome variable. Our prospective study provides evidence that SI-SU with advanced early monitoring and treatment for patients suffering from AIS results in a better outcome 1 year after ischemic stroke if compared with conventional care.
Walter
Andreas
A
National Association of Statutory Health Insurance Physicians, Berlin, Germany.
Seidel
Guenter
G
Thie
Andreas
A
Raspe
Heiner
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D002546:Ischemic Attack, Transient / Q000451:nursing / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality / Q000451:nursing / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult