Alternative strategies for stroke care: a prospective randomised controlled trial

Background Organised specialist care for stroke improves outcome, but the m erits of different methods of organisation are in doubt. This study compare s the efficacy of stroke unit with stroke team or domiciliary care. Methods A single-blind, randomised, controlled trial was undertaken in 457 acute-stroke patients (average age 76 years, 48% women) randomly assigned t o stroke unit, general wards with stroke team support, or domiciliary strok e care, within 72 h of stroke onset. Outcome was assessed at 3, 6, and 12 m onths. The primary outcome measure was death or institutionalisation at 12 months. Analyses were by intention to treat. Findings 152 patients were allocated to the stroke unit, 152 to stroke team , and 153 to domiciliary stroke care. 51 (34%) patients in the domiciliary group were admitted to hospital after randomisation. Mortality or instituti onalisation at 1 year were lower in patients on a stroke unit than for thos e receiving care from a stroke team (21/152 [14%] vs 45/149 [30%]; p<0.001) or domiciliary care (21/152 [14%] vs 34/144 [24%]; p=0.03), mainly as a re sult of reduction in mortality. The proportion of patients alive without se vere disability at 1 year was also significantly higher on the stroke unit compared with stroke team (129/152 [85%] vs 99/149 [66%]; p<0.001) or domic iliary care (129/152 [85%] vs 102/144 [71%]; p=0.002). These differences we re present at 3 and 6 months after stroke. Interpretation Stroke units are more effective than a specialist stroke tea m or specialist domiciliary care in reducing mortality, institutionalisatio n, and dependence after stroke.