THE EFFECT OF A STROKE UNIT - REDUCTIONS IN MORTALITY, DISCHARGE RATETO NURSING-HOME, LENGTH OF HOSPITAL STAY, AND COST - A COMMUNITY-BASED STUDY

Background and Purpose Treatment of stroke patients in specialized str oke units has become more frequent, yet the effect of this treatment h as not been determined. Methods In a community-based, prospective, and consecutive study of 1241 unselected acute stroke patients, we compar ed outcome of stroke treatment between two neighboring communities wit hin Greater Copenhagen: the Bispebjerg community, where all acute stro ke patients are treated and rehabilitated on a stroke unit, and Freder iksberg community, where all acute stroke patients are treated and reh abilitated on general neurological and medical wards. Except for the d ifferent organization of stroke treatment, the two communities and the two patient groups were comparable. Specifically, age, sex, marital s tatus, prestroke residence, and stroke severity were not statistically different between patients treated on the stroke unit and those treat ed on the general neurological and medical wards. Multivariate regress ion analyses were used to estimate the independent influence of stroke unit treatment on outcome. Results Stroke unit treatment significantl y reduced in-hospital mortality (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.34 to 0.74; P<.001), case-fatality rate (OR, 0.45; C I, 0.28 to 0.71; P<.001), 6-month mortality (OR, 0.57; CI, 0.39 to 0.8 2; P=.002), 1-year mortality (OR, 0.59; CI, 0.42 to 0.84; P=.003), and discharge rate to a nursing home (OR, 0.61; CI, 0.38 to 0.98; P=.04). Discharge rate to the patient's own home was significantly increased (OR, 1.90; CI, 1.30 to 2.70; P<.001). The length of hospital stay (inc luding rehabilitation) was reduced significantly by 30% in patients tr eated on the stroke unit despite their lower mortality (P<.001). The s avings due to stroke unit treatment were estimated at 1313 bed-days an d three places at a nursing home per 100 stroke patients. Conclusions Treatment of unselected acute stroke patients on a stroke care unit sa ved lives, reduced the length of hospital stay, reduced the frequency of discharge to a nursing home, and potentially reduced cost.