Stroke unit care benefits patients with intracerebral hemorrhage: systematic review and meta-analysis.
OBJECTIVE
Patients with any type of stroke managed in organized inpatient (stroke unit) care are more likely to survive, return home, and regain independence. However, it is uncertain whether these benefits apply equally to patients with intracerebral hemorrhage and ischemic stroke.


METHODS
We conducted a secondary analysis of a systematic review of controlled clinical trials comparing stroke unit care with general ward care, including only trials published after 1990 that could separately report outcomes for patients with intracerebral hemorrhage and ischemic stroke. We performed random-effects meta-analyses and tested for subgroup interactions by stroke type.


RESULTS
We identified 13 trials (3570 patients) of modern stroke unit care that recruited patients with intracerebral hemorrhage and ischemic stroke, of which 8 trials provided data on 2657 patients. Stroke unit care reduced death or dependency (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.471-0.92; P=0.0009; I2=60%) with no difference in benefits for patients with intracerebral hemorrhage (RR, 0.79; 95% CI, 0.61-1.00) than patients with ischemic stroke (RR, 0.82; 95% CI, 0.70-0.97; Pinteraction=0.77). Stroke unit care reduced death (RR, 0.79; 95% CI, 0.64-0.97; P=0.02; I2=49%) to a greater extent for patients with intracerebral hemorrhage (RR, 0.73; 95% CI, 0.54-0.97) than patients with ischemic stroke (RR, 0.82; 95%, CI 0.61-1.09), but this difference was not statistically significant (Pinteraction=0.58).


CONCLUSIONS
Patients with intracerebral hemorrhage seem to benefit at least as much as patients with ischemic stroke from organized inpatient (stroke unit) care.
From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King's College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway (B.I.); Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Göteborg University, Sweden (C.B.); Institute of Ageing and Health, Medical School, Newcastle upon Tyne, United Kingdom (H.R.); and Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom (M.S.D., R.A.-S.S.).
Peter
P
Langhorne
Patricia
P
Fearon
Ole M
OM
Ronning
Markku
M
Kaste
Heikki
H
Palomaki
Kostos
K
Vemmos
Lalit
L
Kalra
Bent
B
Indredavik
Christian
C
Blomstrand
Helen
H
Rodgers
Martin S
MS
Dennis
Rustam
R
Al-Shahi Salman
D002545:Brain Ischemia / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000628:therapy*; D003422:Critical Care; D006757:Hospital Units; D006801:Humans; D007297:Inpatients; D016017:Odds Ratio; D010348:Patient Care Team; D020521:Stroke / Q000628:therapy*; D016896:Treatment Outcome
hemorrhagic; meta-analysis; outcome; stroke; stroke units