Effectiveness of stroke units in the treatment of acute stroke

Background: In Germany the implementation of specialized wards for the care of stroke patients is proposed. However, which type of organized inpatient stroke unit care is most effective and which group of patients will benefi t most remains unclear. Methods: Based on the analyses of the Stroke Unit Trialists' Collaboration this paper reports results of randomized and quasi-randomized trials that c ompared organized inpatient (stroke unit) care with contemporary convention al care. The primary analyses examined death, dependency and institutionali zation. Secondary outcome measures included patient quality of life, patien t and carer satisfaction and length of stay in hospital and/or institution. Results: The analysis of twenty trails with 3864 patients showed a reductio n in the rate of deaths in the stroke unit group as compared with the contr ol group (OR 0.83, 95 CI CI 0.71-0.97). The odds of death or institutionali zed care were lower (OR 0.76, 95% CT 0.65-0.90) as were death or dependency (OR 0.75, 95% CI 0.65-0.87). The results were independent of patient age, sex, stroke severity, and type of stroke unit organization. Conclusion: Organized care in stroke units resulted in benefits for stroke patients with regard to survival, independence, and probability of living a t home. However, these results refer exclusively to Anglo-American and Scan dinavian trials. German stroke unit services are organized in a different way. No da ta abou t the effectiveness of the German model is yet available.