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Q J Med 2000; 93: 633-638
© 2000 Association of Physicians

Commentary papers

The evolution of stroke units—towards a more intensive approach?

S. Sinha and E.A. Warburton

From the Stroke Unit, Addenbrooke's Hospital, Cambridge, UK

Introduction

The last five to ten years have seen an intensive research effort to find novel treatments for acute stroke with many more large trials of thrombolytic1,2 and neuroprotective agents.3,4 Unfortunately, none of these treatments have proven effective enough to recommend routine use in acute stroke. Although results from thrombolysis trials are promising,1,2 uncertainty persists about more widespread usage, and it is likely that only a small proportion of stroke patients will ever be eligible for treatment because of the short time window for triage and treatment.5,6 Perhaps the most significant advance in stroke management therefore has not been pharmacological, but concerns the process of care for stroke patients, with convincing evidence that changing the approach to the way stroke patients are managed has a beneficial impact on both mortality and morbidity.7 The concept of organized care on geographically-defined units has given rise to a more disease-specific approach to the management . . . [Full Text of this Article]

The evidence for the efficacy of stroke units

What does the term ‘stroke unit’ mean?

Which types of patient benefit?

Why do stroke units reduce mortality?

Why do stroke units reduce dependency?

Why are stroke units difficult to set up?

Should stroke units be more ‘intensive stroke care units’?

Implications of thrombolytic therapy for acute stroke

Conclusions

Notes

References


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