Do all ischemic stroke subtypes benefit from organized inpatient stroke care?
BACKGROUND
There are limited data on the effectiveness of organized stroke care in different ischemic stroke subtypes in the real-world setting. We analyzed the effect of organized stroke care in all stroke subtypes in a longitudinal cohort study using data from the Registry of the Canadian Stroke Network.


METHODS
Between July 2003 and September 2007, there were 6,223 consecutive patients with ischemic stroke subtype information by Trial of Org 10172 in Acute Stroke Treatment criteria. Subtypes were categorized as large artery atherosclerotic disease, lacunar, cardioembolic, or other. The amount of organized stroke care was quantified using the previously published organized care index (OCI), graded 0-3 based on the presence or absence of occupational therapy or physiotherapy, stroke team assessment, and admission to a stroke unit.


RESULTS
Mortality at 30 days was associated with both stroke subtype and OCI. Higher OCI (defined as score 2-3 compared to 0-1) was strongly associated with lower odds of 30-day mortality in each ischemic stroke subtype (adjusted odds ratio estimates ranged from 0.16 to 0.43, p < 0.001, controlling for age, gender, stroke severity, and medical comorbidities by logistic regression). These estimates were essentially unchanged after excluding patients treated with palliative care. Numbers needed to treat, to prevent 1 death at 30 days, ranged from 4 to 9 across the subtypes.


CONCLUSIONS
A strong association between higher OCI and lower 30-day mortality was apparent in each ischemic stroke subtype. These data suggest that organized stroke care should be provided to stroke patients regardless of stroke subtype.
Smith
E E
EE
Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada T2N 2T9. eesmith@ucalgary.ca
Hassan
K A
KA
Fang
J
J
Selchen
D
D
Kapral
M K
MK
Saposnik
G
G
D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000401:mortality / Q000628:therapy; D002545:Brain Ischemia / Q000401:mortality / Q000628:therapy*; D002170:Canada; D005260:Female; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000401:mortality / Q000628:therapy; D020766:Intracranial Embolism / Q000401:mortality / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012042:Registries; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome