Q J Med 2002; 95: 143-152
© 2002 Association of Physicians
Survival of unselected stroke patients in a stroke unit compared with conventional care
1 From the Department of Medicine, 2 Department of Neurology, and 3 Foundation for Health Services Research (HELTEF), Central Hospital of Akershus, Nordbyhagen, Norway
Received 7 May 2001 and in revised form 3 January 2002
Background: Recent meta-analyses have reported a beneficial effect of stroke units compared with traditional care, both on patient survival and on dependency after one year.
Aim: To determine whether these results can be reproduced outside a clinical trial setting.
Setting: A medium-sized general hospital.
Methods: From 1993 to 1998, all patients aged >60 years with suspected acute stroke were allocated either to a stroke unit or general medical wards according to date of birth (day of the month). Patients were identified retrospectively, using a discharge diagnosis of ICD-9 codes 431, 434 and 436. We assessed 30-day and 1-year survival.
Results: In the stroke unit, 926/1128 patients survived at 30 days, vs. 905/1141 in the general medical wards (p=0.08). Beyond the first 30 days, there was no difference in survival (p=0.27). Under Cox regression analysis, there was a 20% reduction in mortality in the stroke unit after 30 days compared with the general medical wards (RR 0.80, p=0.02) after adjusting for age, gender, stroke type and season of the year.
Discussion: In this, the largest single-centre study to evaluate the survival benefit of a stroke unit, survival at 30 days was increased, although not significantly so. Survival at one year was unchanged.
Address correspondence to Dr K. Stavem, Department of Medicine, Central Hospital of Akershus, N-1474 Nordbyhagen, Norway. e-mail: knut.stavem{at}klinmed.uio.no