Should mild or moderate stroke patients be admitted to an intensive care unit?

Background and Purpose-Inhospital placement of patients with mild (National institutes of Health Stroke Scale [NIHSS] score <8) or moderate (NIHSS 8 t hrough 16) acute strokes is variable. We assessed the outcome of such patie nts based on intensive care unit (ICU) versus general ward placement. Methods-We reviewed 138 consecutive patients admitted within 24 hours of st roke onset to 2 physically adjacent hospitals with different admitting prac tices. Outcome measures included complication rates, discharge Rankin scale score, hospital discharge placement, costs, and length of stay (LOS). Results-Hospital A, a 626-bed university-affiliated hospital, admitted 43% of mild and moderate strokes (MMS) to an ICU (26% of mild, 74% of moderate) , whereas hospital B, a 618-bed community facility, admitted 18% of MMS to an ICU (3% of mild, 45% of moderate; P<0.004). There were no significant di fferences in outcomes between the 2 hospitals. Analysis of only patients ad mitted to hospital A, and of all patients, demonstrated that mild stroke pa tients admitted to the general ward had fewer complications and more favora ble discharge Rankin scale scores than similar patients admitted to an ICU, There was no statistically significant difference in LOS, but total room c osts for a patient admitted first to the ICU averaged $15 270 versus $3638 for admission directly to the ward. Conclusions-While limited by the retrospective nature of our study, routine ly admitting acute MMS patients to an ICU provides no cost or outcomes bene fits.