Background: The efficacy of stroke units (SU) has been amply demonstrated in randomised trials. However, no long-term studies analysed their effectiveness in daily practice over several years of operation. Methods: Observational study from the stroke data bank of our neurology ward that includes consecutive stroke patients hospitalised since the SU was established in 1995 until the year 2002 (8 years). Clinical effectiveness was analysed in terms of mortality on day 7, in-hospital mortality, functional state at discharge, length of stay, in-hospital complications and long-term hospitalisation rates on a yearly basis using for comparisons χ² or Student t tests between the first and last 4 years of SU operation. Case-mix adjustments for baseline imbalances and stepwise multivariate logistic regression were also performed for comparative purposes. Results: 3,986 consecutive in-patients were included. No significant differences in the proportion of independent patients at discharge (73.9 vs. 74.5%; n.s.), length of stay (11.2 vs. 11.3 days; n.s.), in-hospital complications (25.0 vs. 25.9%; n.s.) or long-stay hospitalisation (6.3 vs. 6.4%; n.s.) were found comparing the first and last 4 years of SU operation. No significant differences in in-hospital mortality were found after adjustment by case-mix and length of stay. Conclusions: SU effectiveness, in terms of length of stay, death or dependence and long-term hospitalisation, is sustained over the period of operation.

Background and Purpose-We aimed to analyze the frequency of persistent hyperglycemia (PH), its implications for outcome, and to document the inpatient management of hyperglycemia. Methods-Post hoc analysis of the GLIAS (Glycemia in Acute Stroke) study, a multicenter, prospective, and observational cohort study of 476 acute ischemic stroke patients. Capillary finger-prick glucose was determined on admission and during the first 48 hours. We defined PH was defined as at least 2 values Ն155 mg/dL. Outcome (modified Rankin Scale) was evaluated at 3 months. Results-PH developed in 117 patients (24.7%). PH was associated with poorer outcome (modified Rankin Scale score Ͼ2: 56.2% vs 28.1%; PϽ0.01) and higher mortality (26.7% vs 5.9%; PϽ0.01) than those with glycemia Ͻ155 mg/dL. PH Ն155 mg/dL was associated with a 4-fold increase in the odds of poor outcome at 3 months (odds ratio, 4.7; 95% confidence interval, 2.2-10.2) after adjustment for age, gender, hypertension, diabetes, stroke severity, admission glycemia, and infarct volume. Only 20% of patients with hyperglycemia Ն155 mg/dL received insulin on admission, with a progressive increase in the use of insulin during the following 48 hours. However, 114 (39.1%) out of 291 patients who received corrective treatment for hyperglycemia still had levels Ն155 mg/dL. Conclusions-PH Ն155 mg/dL is a common observation in acute ischemic stroke patients that is associated with poorer outcome and higher mortality. Almost 40% of patients maintained levels Ն155 mg/dL despite corrective treatment. (Stroke. 2010;41:2362-2365.)

Our study suggests that prestroke treatment with ARB may be associated with reduced stroke severity and also with better outcome. This finding agrees with experimental data that suggest a cerebral protective effect.