David Tong, MD, FAHA
In patients hospitalized with stroke, does organized stroke unit (OSU) care improve patient outcomes more than alternative forms of care?
Articles selected compared OSU care with alternative care in patients who were hospitalized with stroke.
Outcomes included mortality and composite outcomes of mortality and dependence (need for physical assistance with transfers, mobility, dressing, feeding, or toileting) or need for institutional care (residential or nursing home care, or continued hospitalization) at the end of scheduled follow-up.
Cochrane Stroke Group Trials Register (April 2006) and reference lists were searched for randomized or quasi-randomized controlled trials. Experts and coordinators of included trials were also consulted. Stroke was defined as a focal neurologic deficit due to cerebrovascular disease, excluding subarachnoid hemorrhage and subdural hematoma. Core features of inpatient OSUs included provision of a complex package of care delivered by a multidisciplinary team specializing in stroke management. 31 trials (n = 6936; median follow-up 12 mo) were included. 16 trials reported an adequate method for allocation concealment, and 10 used blinding for the final assessment; 9 trials had missing data.
Meta-analyses showed that inpatient OSUs reduced mortality after stroke more than alternative forms of care and more than care on general medical wards (Table). Results for mortality were consistent at 5-year (3 trials, n = 1139, relative risk reduction [RRR] 12%, 95% CI 3 to 21) and 10-year (2 trials, n = 535, RRR 13%, CI 5 to 21) follow-up. For composite outcomes of mortality and institutional care or dependence, meta-analyses showed that OSUs reduced event rates more than alternative forms of care, including care on general medical wards (Table). Results of prespecified subgroup analyses comparing different forms of inpatient OSUs (1 to 4 trials in each analysis) were mixed.
In patients hospitalized with stroke, care in organized stroke units reduces mortality more than alternative forms of care.
Organized stroke unit care vs alternative forms of care for patients hospitalized with stroke*
*Abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article using a fixed-effects model.
Tong D. Review: Organized stroke unit care reduces mortality more than other forms of care in patients hospitalized with stroke. Ann Intern Med. ;148:JC4–3. doi: 10.7326/0003-4819-148-12-200806170-02003
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Published: Ann Intern Med. 2008;148(12):JC4-3.
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