Stroke unit care--who benefits? Comparisons with general medical care in relation to prognostic indicators on admission.

Abstract

SUMMARY The clinical outcome in 110 patients admitted to a non-intensive stroke unit was compared to that in 183 patients treated for acute stroke in general medical wards. At entry, the two groups of patients were closely similar in all prognostic indicators. Subsets of patients were analyzed in an attempt to identify groups that benefit more than others from stroke unit care.The stroke unit regime had little effect on short-term and long-term mortality rates in the entire stroke population as well as in subgroups. But after the care in the stroke unit, the need for long-term hospitalizatlon hi survivors was reduced (p = 0.0001). This difference hi favour of the stroke unit was independent of the patients' age, the extent of neurological deficit on admission and previous history. In subgroups where the general prognosis is fair or good (minor neurological deficits and < 75 yrs), SU care accelerated the process of rehabilitation, but the need for institutional care very late after the stroke was influenced only little. In groups with a poor general prognosis (major deficits and > 75 yrs), the ultimate proportion of patients able to return home was enhanced by SU care. It is concluded that care in a stroke unit benefits the great majority of stroke patients and that such a unit should be designed to admit all acute stroke patients without selection.

Acute Stroke in the Very Elderly

“…This constitutes a paradox because studies have shown that older stroke patients, who generally have a poor clinical prognosis, benefit more from active medical care than younger patients. 29 Stroke management appears to be one of the most important modifiable prognostic factors in older patients, and we believe that a special effort must be made to improve medical care in this older age group.…”

Effect of Acute Stroke Unit Care Integrated With Care Continuum Versus Conventional Treatment: A Randomized 1-Year Study of Elderly Patients

“…Subgroup analyses were performed for patients with mild, moderate, and severe stroke (Barthel Index of 50 to 100, 15 to 45, and 0 to 10, respectively, during the first 3 days) and for patients with cardiac disease. 1,33 All results were analyzed according to the intention-to-treat principle. Differences between groups in the proportion of patients at home, deceased, or dependent were compared with the use of the Fisher exact test.…”

Manejo da hipertensão arterial na isquemia cerebral aguda

“…São apresentandas na Tabela 3, as indicações de acordo com os níveis tensionais, para o uso de cada uma delas, baseando-se em protocolos de alguns estudos, particularmente o da American Heart Association (AHA) 7,12,15 . Ao contrário de alguns autores 24,25 , acreditamos que a nifedipina não deve ser usada, devido a sua resposta hipotensiva abrupta 15 . Deve-se ter especial atenção com a hidralazina, tendo em vista a dificuldade de se prever a intensidade do seu efeito 7 .…”

“…Alguns estudos têm mostrado que as "stroke units" reduzem os índices de morbidade e de mortalidade precoce, além de serem economicamente vantajosas, quando comparadas ao tratamento na enfermaria 20,24,25 .…”