title: Identification of stroke etiology may contribute to improve the outcome in dedicated units.
abstract: BACKGROUND
  The purpose of our study is to investigate whether stroke unit (SU) care and the utilization of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria may contribute to reduce death and disability in hospitalized patients after a first-ever ischemic stroke (IS).
  
  
  METHODS
  Data included in the present study were derived from our previous study on the incidence and outcome of cerebrovascular diseases in the district of Udine, performed from April 1, 2007, to March 31, 2009.
  
  
  RESULTS
  We identified 429 hospitalized first-ever IS cases, 297 of 429 (69.2%) patients were admitted to a dedicated SU and 132 of 429 (30.8%) to a general medical ward. According to the TOAST criteria, 101 of 132 first-ever ISs (76.5%) admitted to general medical wards were of undetermined (UND) etiology, whereas in only 105 of 297 (35.4%) patients admitted to the SU, the diagnosis remained UND. Multivariable analysis after propensity score matching showed that compared with general medical wards, SU care was associated with a reduced probability of being dead or highly disabled (P = .025) at the end of follow-up. Moreover, patients with an UND diagnosis had a worse 6-month case fatality (P < .0001) and also higher risk of being dead or highly disabled (P < .0001).
  
  
  CONCLUSIONS
  Our study provides real-world evidence that accurate etiologic subtype classification of ISs according to TOAST criteria and SU care as opposed to general medical ward management are associated with reduction of the proportion of poor outcomes in first-ever IS patients.
authors: Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy. Electronic address: luciodanna@hotmail.it.
authors: Lucio
authors: L
authors: D'Anna
authors: Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy.
authors: Gian L
authors: GL
authors: Gigli
authors: Section of Statistics, Department of Medical and Biological Sciences, University of Udine, Udine, Italy; Department of Medical and Biological Sciences, Institute of Hygiene and Clinical Epidemiology, University of Udine, Udine, Italy.
authors: Giorgia
authors: G
authors: Gregoraci
authors: Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy.
authors: Giessica
authors: G
authors: Canal
authors: Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy.
authors: Federico
authors: F
authors: Giopato
authors: Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy.
authors: Francesco
authors: F
authors: Janes
authors: Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy.
authors: Anna
authors: A
authors: Perelli
authors: Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy.
authors: Valentina
authors: V
authors: Russo
authors: Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy.
authors: Barbara
authors: B
authors: Zanchettin
authors: Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy.
authors: Mariarosaria
authors: M
authors: Valente
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000145:classification / Q000175:diagnosis* / Q000209:etiology*; D016896:Treatment Outcome
keywords: Ischemic stroke; TOAST criteria; ischemic stroke subtypes; medical ward; stroke unit care; vascular events