Organised inpatient (stroke unit) care for stroke

Abstract

Background: Organised stroke unit care is provided by multidisciplinary teams that exclusively manage stroke patients in a dedicated ward (stroke ward), with a mobile team (stroke team) or within a generic disability service (a mixed rehabilitation ward).

Objectives: The objective of this review was to assess the effect of stroke unit care compared with alternative forms of care for patients following a stroke.

Search strategy: We searched the Cochrane Stroke Group trials register, reference lists of articles and contacted researchers in the field.

Selection criteria: Randomised and quasi-randomised trials comparing organised inpatient stroke unit care with an alternative service.

Data collection and analysis: Two reviewers independently assessed eligibility and trial quality. The principal reviewer conducted a structured interview with the coordinators of unpublished trials.

Main results: Twenty three trials were included. Compared with alternative services, stroke unit care showed reductions in the odds of death recorded at final (median one year) follow-up (odds ratio 0.86; 95% confidence interval 0.71 to 0.94; P=0.005), the odds of death or institutionalised care (0.80; 0.71 to 0.90; P=0.0002) and death or dependency (0.78; 0.68 to 0.89; P=0.0003). Subgroup analyses indicated that the observed benefits remained when the analysis was restricted to truly randomised trials with blinded outcome assessment. Outcomes were independent of patient age, sex and stroke severity but appeared to be better in stroke units based in a discrete ward. There was no indication that organised stroke unit care resulted in increased hospital stay.

Reviewer's conclusions: Stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke. The benefits were most apparent in units based in a discrete ward. No systematic increase was observed in the length of inpatient stay.