Evidence for specialist stroke units

The effects of dedicated stroke units has been systematically reviewed:

• the authors performed a meta-analysis of 19 randomised trials comparing outcomes for patients treated in a dedicated stroke unit versus any other ward setting (1)

Patients in the dedicated stroke unit had a relative risk of:

• death at follow-up (median 1 year) of 0.83 (95% CI 0.69 to 0.98; p<0.05)
• death or dependency of 0.69 (95% CI 0.59 to 0.82; p<0.0001)
• death or institutionalisation of 0.75 (95% CI 0.65 to 0.87; p<0.0001)

The length of stay was 8% shorter in the stroke units.

The benefits of the stroke unit were independent of age, sex and severity of the stroke.

An updated systematic review revealed that (2):

• stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke
  • benefits were most apparent in units based in a discrete ward
  • no systematic increase was observed in the length of inpatient stay

Reference:

• (1) Stroke Unit Trialists' Collaboration. Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997; 314: 1151-9.
• (2) Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000197