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Centre for Evidence-
Based Medicine

Systematic Reviews: Clinical Scenario

You are referred a 75 year old man with a stroke who had been admitted one day previously to general medicine. He has left-sided weakness and has difficulty with ambulating, bathing, feeding and dressing himself. He has hypertension which is well-controlled with a diuretic. He is otherwise well and you decide to transfer him to a stroke unit. His family is concerned because they live close to the hospital where he is currently as an inpatient and want to know why he needs to be transferred to a stroke unit of a different hospital and why he can't stay on the general medicine ward. You (with them) formulate the question: "In a patient with a stroke, does admission to a stroke unit decrease the risk of death and dependency?"

You search Best Evidence using the terms "stroke unit" and "death" and find a promising systematic review. The abstract and commentary look helpful and you decide to retrieve the complete article. BMJ 1997;314:1151-9.

Read the article and decide:

  1. Is the evidence from this systematic review valid?
  2. Is this valid evidence from this systematic review important?
  3. Can you apply this valid and important evidence from this systematic review in caring for your patient?

Continue to completed worksheet