A stroke unit within a department of medicine that provides general medical care: a model and preliminary clinical results

Background and objectives: To achieve in Germany complete therapeutic cover for patients after a stroke, models will have to be formulated that incorp orate such units within the confines of departments of general medicine, wh ere most stroke patients are at present being treated. Preliminary experien ce of such a unit is reported here. Patients and methods: The stroke unit, conceived for "mixed assessment", ha s 6 beds within a normal ward but an increased number of specially trained personnel and specialized equipment. The aim was the rapid diagnosis, targe ted treatment, monitoring, early mobilization and, if necessary, smooth and direct transfer to an installation for rehabilitation to which the patient can be taken during the entire stay in the acute stroke unit. Results: During a period of 11 months 120 patients (68 men, 52 women; mean age 71 years) were treated in the stroke unit, 47% having been admitted wit hin 3 hours of the acute episode. An acute ischaemic attack had occurred in 85%, cerebral haemorrhage in 15%. The median European stroke scale (ESS) w as 76 on admission, 90,5 on discharge, the Barthel index 45 and 90, the ran king scale 3.2 and 2.3, respectively. The complication rate per patient dur ing hospital stay was 0.5. There were 12 deaths (10%), 22.2% among those wi th cerebral bleeding, 7.7% of those with ischaemia. Mean hospital stay was 13.3 days. 57,4% patients were transferred to a rehabilitation unit, 34,2% discharged home, 2.8% directly to a nursing home, The remaining 6 had under gone immediate vascular (4) or neurological (2) procedures. Conclusion: A "mixed assessment" stroke unit within a general medical depar tment is feasible. It improves working conditions and patient care as well as reducing the length of hospital stay.