Organised inpatient (stroke unit) care for stroke

Stroke Unit Trialists' Collaboration

Published Online:

January 21, 2009

Organised stroke unit care is a form of care provided in hospital by nurses, doctors and therapists who specialise in looking after stroke patients and work as a co-ordinated team. This review of 31 trials, involving 6936 participants, showed that patients who receive this care are more likely to survive their stroke, return home and become independent in looking after themselves. A variety of different types of stroke unit have been developed. The best results appear to come from those which are based in a dedicated ward.

Abstract (click to read)

Background:

Organised stroke unit care is provided by multidisciplinary teams that exclusively manage stroke patients in a dedicated ward (stroke, acute, rehabilitation, comprehensive), with a mobile stroke team or within a generic disability service (mixed rehabilitation ward).

Objectives:

To assess the effect of stroke unit care compared with alternative forms of care for patients following a stroke.

Search strategy:

We searched the Cochrane Stroke Group trials register (last searched April 2006), the reference lists of relevant articles, and contacted researchers in the field.

Selection criteria:

Randomised and prospective controlled clinical trials comparing organised inpatient stroke unit care with an alternative service.

Data collection and analysis:

Two review authors initially assessed eligibility and trial quality. Descriptive details and trial data were then checked with the co-ordinators of the original trials.

Main results:

Thirty-one trials, involving 6936 participants, compared stroke unit care with an alternative service; more organised care was consistently associated with improved outcomes. Twenty-six trials (5592 participants) compared stroke unit care with general wards. Stroke unit care showed reductions in the odds of death recorded at final (median one year) follow up (odds ratio (OR) 0.86; 95% confidence interval (CI) 0.76 to 0.98; P = 0.02), the odds of death or institutionalised care (OR 0.82; 95% CI 0.73 to 0.92; P = 0.0006) and death or dependency (OR 0.82; 95% CI 0.73 to 0.92; P = 0.001). Sensitivity analyses indicated that the observed benefits remained when the analysis was restricted to trials that used formal randomisation procedures with blinded outcome assessment. Outcomes were independent of patient age, sex or stroke severity, but appeared to be better in stroke units based in a discrete ward. There was no indication that organised stroke unit care resulted in a longer hospital stay.

Authors' conclusions:

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. The benefits were most apparent in units based in a discrete ward. No systematic increase was observed in the length of inpatient stay.

This record should be cited as:

Stroke Unit Trialists' Collaboration . Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000197. DOI: 10.1002/14651858.CD000197.pub2

Assessed as up to date:

November 28, 2006

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Primary Review Group:

Stroke Group

Health topics:

Heart & circulation > Stroke > Organization of stroke services: hospital care

Neurology > Stroke > Organization of stroke services

Effective practice/health systems > Reviews of specific types of interventions > Organizational interventions

Heart & circulation > Stroke > Organization of stroke services

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Organised inpatient (stroke unit) care for stroke

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