Effects of Stroke Unit Care in Acute Ischemic Stroke Patient Ineligible for Thrombolytic Treatment

Abstract

Background: Several trials have verified the benefits of stroke unit (SU) in acute stroke care worldwide.

Objective: Compare clinical outcomes and costs of care in acute ischemic stroke patients who were ineligible for thrombolytic treatment (recombinant tissue plasminogen activator-rt PA) in a primary stroke center.

Material and method: A prospective study was conducted in acute ischemic stroke patients, aged 15 years old and above, presenting within 72 hours of onset. At discharge, neurological and medical complications, mortality rate, National Institutes of Health Stroke Scale (NIHSS), Barthel Activities of Daily Living (Barthel ADLs Index), and modified Rankin Scale (mRS) for disability were measured, as well as the length of stay, and cost of hospital care.

Results: There were 1,110 acute ischemic stroke patients, 472 subjects (42.52%) in general medical ward (GMW), and 638 subjects (57.48%) in stroke unit (SU). The number of neurological (brain edema, hemorrhagic transformation, or recurrent stroke), and medical complications (gastrointestinal hemorrhage, pneumonia, or pressure sore) in GMW had highly statistical significance (p<0.001, p<0.001) more than those in SU, with adjusted OR (aOR) (95% CI) of 84.53 (31.14 to 229.46), 4.03 (1.99 to 8.17), respectively. Whereas, the death rate, NIHSS, and disability (Barthel Index of ADLs, and mRS) were statistically significant lower among SU cases (p = 0.05, p<0.001, p<0.001) respectively. The median length of stay was three days in both groups, while the median cost of in hospital care was 10,206 Thai Bahts in SU, which was 15.23% higher (p<0.001).

Conclusion: The stroke unit increases the survival rate among stroke patient compared with the general medical ward and have less complication.