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Centre for Evidence-
Based Medicine

Stroke - Stroke units decrease death, dependency and institutionalisation

Clinical Bottom Line

Stroke units decrease death and dependency, and death and institutionalisation.

Citation

Stroke unit trialists' collaboration. Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997;314:1151-9.

Clinical Question

In a patient with a stroke, does admission to a stroke unit decrease the risk of death and dependency?

Search Terms

"stroke unit" and "death" in Best Evidence

The Study

Systematic review of RCTs that studied dedicated stroke units, mixed assessment and rehab units or general medical wards with outcomes of death, dependency or institutionalisation

The Evidence

Outcomes* CER (weighted) EER (weighted) RRR (95% CI) ARR (weighted) NNT (95% CI)
death and dependency 0.679 0.611 9% (16 to 39) 0.068 15 (12 to 41)
death and institutionalisation 0.475 0.377 18% (6 to 28) 0.098 11 (7 to 32)
*dependency defined as the need for physical assistance with transfers, mobility, feeding, dressing or toileting. Institutionalisation included nursing home placement, residential care placement or hospitalisation at the end of the rehab period.

Comments

  1. mortality rate 21% in the stroke unit and 25% in the general medicine group
  2. heterogeneity in death or dependency amongst the trials but seems to reflect the nature of the control group
  3. advantages as great in older patients as in younger patients and in those who have had severe stroke as in those who have had milder strokes
  4. little difference in staff numbers or mix or in intensity of rehab provided in organised vs conventional care settings but tendency for assessment and treatment to begin earlier in organised settings
  5. most significant difference were the degree of specialised medical and nursing interest in stroke, staff training and involvement of family and caregivers in the rehab process

Appraised By

Straus, 1998

Expiry Date

2000