Stroke care units versus general medical wards for acute management of stroke in Japan

Abstract

Background and purpose: The Japanese stroke guideline recommends the use of stroke care units (SCUs) for acute stroke treatment, but few SCUs have been established and the evidence supporting their use is limited. The aim of this study was to evaluate the efficacy of SCUs compared with general medical wards (GMWs).

Methods: A multicenter observational study was conducted using a large administrative database involving 52 hospitals; patients with either intracerebral hemorrhage or cerebral infarction were included. In-hospital mortality was the primary end point, and this parameter as well as the proportion of patients with a modified Rankin Scale score of ≤2 at discharge were compared between patients who were treated at SCUs and GMWs. Propensity score matching was performed to correct for selection bias.

Results: A total of 6977 patients were identified, of which 4527 patients were admitted to SCUs and 2450 patients were admitted to GMWs. The in-hospital mortality of patients with intracerebral hemorrhage was 14.8% and 24.1% in SCUs and GMWs, respectively (P=0.0004); the mortality of patients with cerebral infarction was 3.6% and 5.7%, respectively (P=0.003). Multivariate analysis in propensity score-matched pairs indicated significantly lower risk of death in the SCU group among patients with both intracerebral hemorrhage (odds ratio, 0.36; P=0.0007) and cerebral infarction (odds ratio, 0.60; P=0.02). However, the proportions of patients with a modified Rankin Scale score of ≤2 were not significantly different between SCUs and GMWs.

Conclusions: SCUs were associated with a reduced risk of in-hospital mortality of stroke patients compared with GMWs alone.

Keywords: Japan; hospital mortality; propensity score; wards, general.