BACKGROUND AND PURPOSE: Randomised trials indicate that organised inpatient (stroke unit) care has an important impact on patient outcomes with an absolute risk difference (ARD) of 3% for survival and 5% for returning home. However, it is unclear what impact this complex intervention actually has in routine practice. A comprehensive national dataset was used to study the impact of stroke unit implementation. METHODS: The Scottish linked discharge database was used to identify all patients admitted to hospital with an incident stroke. Analyses compared case fatality and discharge home (adjusted for age, sex, deprivation and comorbidity) for hospitals with or without a stroke unit during four consecutive study periods: 1986-1990, 1991-1995, 1996-2000 and 2001-2005. RESULTS: During the study period, the percentage of admissions to hospitals that had a stroke unit increased from 0% to 87%, the 6 month case fatality decreased from 45% to 29% and discharges home increased from 46% to 59%. Adjusted ORs (95% CI) for case fatality (stroke unit versus no unit) in each study period were as follows: not calculable (no units before 1991), 0.83 (0.78-0.89), 0.90 (0.86-0.94) and 0.87 (0.82-0.91). These equate to an ARD of 3.0% over the whole study period. Equivalent data for discharge home indicated an increased odds of discharge home: not calculable, 1.23 (1.15-1.31), 1.15 (1.10-1.21) and 1.17 (1.11-1.23) with an overall ARD of 5%. CONCLUSIONS: These results indicate a positive impact of a policy of stroke unit care on case fatality and discharge home. The estimated impact, after adjusting for case mix, appears very similar to that calculated using clinical trial data.
BACKGROUND AND PURPOSE: Randomised trials indicate that organised inpatient (stroke unit) care has an important impact on patient outcomes with an absolute risk difference (ARD) of 3% for survival and 5% for returning home. However, it is unclear what impact this complex intervention actually has in routine practice. A comprehensive national dataset was used to study the impact of stroke unit implementation. METHODS: The Scottish linked discharge database was used to identify all patients admitted to hospital with an incident stroke. Analyses compared case fatality and discharge home (adjusted for age, sex, deprivation and comorbidity) for hospitals with or without a stroke unit during four consecutive study periods: 1986-1990, 1991-1995, 1996-2000 and 2001-2005. RESULTS: During the study period, the percentage of admissions to hospitals that had a stroke unit increased from 0% to 87%, the 6 month case fatality decreased from 45% to 29% and discharges home increased from 46% to 59%. Adjusted ORs (95% CI) for case fatality (stroke unit versus no unit) in each study period were as follows: not calculable (no units before 1991), 0.83 (0.78-0.89), 0.90 (0.86-0.94) and 0.87 (0.82-0.91). These equate to an ARD of 3.0% over the whole study period. Equivalent data for discharge home indicated an increased odds of discharge home: not calculable, 1.23 (1.15-1.31), 1.15 (1.10-1.21) and 1.17 (1.11-1.23) with an overall ARD of 5%. CONCLUSIONS: These results indicate a positive impact of a policy of stroke unit care on case fatality and discharge home. The estimated impact, after adjusting for case mix, appears very similar to that calculated using clinical trial data.
Authors: Aravind Ganesh; Patrice Lindsay; Jiming Fang; Moira K Kapral; Robert Côté; Ian Joiner; Antoine M Hakim; Michael D Hill Journal: Neurology Date: 2016-02-05 Impact factor: 9.910
Authors: Daniel T Lackland; Edward J Roccella; Anne F Deutsch; Myriam Fornage; Mary G George; George Howard; Brett M Kissela; Steven J Kittner; Judith H Lichtman; Lynda D Lisabeth; Lee H Schwamm; Eric E Smith; Amytis Towfighi Journal: Stroke Date: 2013-12-05 Impact factor: 7.914
Authors: Steffi Hillmann; Silke Wiedmann; Viktoria Rücker; Klaus Berger; Darius Nabavi; Ingo Bruder; Hans-Christian Koennecke; Günter Seidel; Björn Misselwitz; Alfred Janssen; Christoph Burmeister; Christine Matthis; Otto Busse; Peter Hermanek; Peter Ulrich Heuschmann Journal: BMC Neurol Date: 2017-03-09 Impact factor: 2.474
Authors: Juliet Addo; Siobhan Crichton; Ajay Bhalla; Anthony G Rudd; Charles D A Wolfe; Christopher McKevitt Journal: PLoS One Date: 2013-04-25 Impact factor: 3.240
Authors: Farasat As Bokhari; Ian Wellwood; Anthony G Rudd; Peter Langhorne; Martin S Dennis; Charles D A Wolfe Journal: Health Econ Rev Date: 2014-01-09
Authors: Stephen Morris; Rachael M Hunter; Angus I G Ramsay; Ruth Boaden; Christopher McKevitt; Catherine Perry; Nanik Pursani; Anthony G Rudd; Lee H Schwamm; Simon J Turner; Pippa J Tyrrell; Charles D A Wolfe; Naomi J Fulop Journal: BMJ Date: 2014-08-05