Stroke Units

Note: This module differs from others on StrokeEngine in that conclusions are based mainly on the findings of a recent meta-analysis (Stroke Unit Trialists’ Collaboration, 2007), as opposed to the synthesis of individual studies by the StrokEngine team. Please note that newer studies not included in the meta-analysis will be added to the module shortly.

Rating of interventions: 

In this module, an intervention is given the rating of:

1. Effective if the meta-analysis revealed an effect of treatment that was significant

2. Effective* if the meta-analysis revealed an effect of treatment that approached significance,

3. May not be effective if an effect was found, however the effect was not significant nor did it approach significance,

4. Not effective if none of the 3 conditions above are met

The following list describes the different types of organized stroke care analyzed in this review, ranging from most organized to least organized:

Types of organized stroke care:

1. Stroke ward: a multidisciplinary team including specialist nursing staff based in a discrete ward caring exclusively for patients with stroke. This category includes the following sub-divisions:

a. Acute stroke units, which accept patients acutely but discharge early (usually within 7 days).

b. Rehabilitation stroke units, which accept patients after a delay, usually of seven days or more, and focus on rehabilitation; and,

c. Comprehensive stroke units, which accept patients acutely but also, provide rehabilitation for at least several weeks if necessary. Both the rehabilitation unit and comprehensive unit models offered prolonged periods of rehabilitation.

2. Mixed rehabilitation ward: a multidisciplinary team including specialist nursing staff in a ward providing a generic rehabilitation service but not exclusively caring for patients with stroke.

3. Mobile stroke team: a multidisciplinary team (excluding specialist nursing staff) providing care in a variety of setting.

4. General medical wards are defined as care in an acute medical or neurology ward without routine multidisciplinary input.

Overall organized stroke care

Death by the end of scheduled follow upEffective1
NOTE: This section compares overall organized stroke with general medical wards. For a breakdown of each type of stroke unit compared to general medical wards please see the next sections.

 

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of overall organized stroke care (which includes rehabilitation stroke units, comprehensive stroke units, mixed rehabilitation wards, and mobile stroke teams) for reducing death by the end of scheduled follow up in patients with stroke as compared to general medical wards. The analysis revealed a significant effect (OR= 0.86, 95% CI= 0.76, 0.98).

Conclusion: There is evidence from 1 meta-analysis that organized stroke care is effective in reducing death by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Death or dependency by the end of scheduled follow upEffective1
NOTE: This section compares overall organized stroke with general medical wards. For a breakdown of each type of stroke unit compared to general medical wards please see the next sections.

 

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of overall organized stroke care (which includes rehabilitation stroke units, comprehensive stroke units, mixed rehabilitation wards, and mobile stroke teams) for reducing death or dependency by the end of scheduled follow up in patients with stroke as compared to general medical wards. The analysis revealed a significant effect (OR= 0.82, 95% CI= 0.73, 0.92).

Conclusion: There is evidence from 1 meta-analysis that organized stroke care is effective in reducing death or dependency by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Death or institutional care by the end of scheduled follow upEffective1
NOTE: This section compares overall organized stroke with general medical wards. For a breakdown of each type of stroke unit compared to general medical wards please see the next sections.

 

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of overall organized stroke care (which includes rehabilitation stroke units, comprehensive stroke units, mixed rehabilitation wards, and mobile stroke teams) for reducing death or institutional care by the end of scheduled follow up in patients with stroke as compared to general medical wards. The analysis revealed a significant effect (OR= 0.82, 95% CI= 0.73, 0.92).

Conclusion: There is evidence from 1 meta-analysis that organized stroke care is effective in reducing death or institutional care by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Length of stay (days) in a hospital or institutionEffective*2
NOTE: This section compares overall organized stroke with general medical wards. For a breakdown of each type of stroke unit compared to general medical wards please see the next sections.

 

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of overall organized stroke care (which includes rehabilitation stroke units, comprehensive stroke units, mixed rehabilitation wards, and mobile stroke teams) for reducing length of stay (days) in a hospital or institution in patients with stroke as compared to general medical wards. The analysis revealed an effect that approached significance (SMD= -0.11, 95% CI= -0.23, 0.01).

Conclusion: There is evidence from 1 meta-analysis that organized stroke care is effective* in reducing length of stay (days) in a hospital or institution as compared to general medical wards in patients with stroke
Note:
The effect of treatment approached significance.

Rehabilitation stroke ward vs. general medical ward

Death by the end of scheduled follow upEffective*2

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of rehabilitation stroke units for reducing death by the end of scheduled follow up in patients with stroke as compared to general medical wards. The analysis revealed an effect that approached significance (OR= 0.69, 95% CI= 0.46, 1.05).

Conclusion: There is evidence from 1 meta-analysis that rehabilitation stroke units are effective* in reducing death by the end of scheduled follow up as compared to general medical wards in patients with stroke.
Note:
The effect of treatment approached significance.

Death or dependency by the end of scheduled follow upMay not be effective3

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigating the effectiveness of organized stroke care revealed a reduction in death or dependency by the end of scheduled follow up in favour of rehabilitation stroke units as compared to general medical wards, however the effect was not statistically significant (OR= 0.83, 95% CI= 0.57, 1.23).

Conclusion: There is evidence from 1 meta-analysis that rehabilitation stroke units may not be effective for reducing death or dependency by the end of scheduled follow up as compared to general medical wards in patients with stroke.
Note:
While the analysis did reveal lowered odds for death or dependency by the end of scheduled follow up, the results were not statistically significant.

Death or institutional care by the end of scheduled follow upEffective*2

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigating the effectiveness of rehabilitation stroke units in patients with stroke revealed a reduction in death by the end of scheduled follow up that approached significance compared to general medical wards (OR= 0.76, 95% CI= 0.52, 1.09).

Conclusion: There is evidence from 1 meta-analysis that rehabilitation stroke units are effective* in reducing death or institutional care by the end of scheduled follow up as compared to general medical wards in patients with stroke
Note:
The effect of treatment approached significance.

Length of stay (days) in a hospital or institutionNot effective4

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigating the effectiveness of organized stroke care revealed that rehabilitation stroke units do not reduce length of stay compared to general medical wards (SMD=  0.37, 95% CI= 0.07, 0.67).

Conclusion: There is evidence from a meta-analysis that rehabilitation stroke units are not effective in reducing length of stay as compared to general medical wards in patients with stroke.

Comprehensive stroke ward vs. general medical ward

Death by the end of scheduled follow upEffective1

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of comprehensive stroke units for reducing death by the end of scheduled follow up, and compared to general medical wards, and revealed a significant effect (OR= 0.85, 95% CI= 0.72, 0.99).

Conclusion: There is evidence from 1 meta-analysis that comprehensive stroke units are effective in reducing death by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Death or dependency by the end of scheduled follow upEffective1

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigating the effectiveness of comprehensive stroke units revealed a significant reduction (OR= 0.83, 95% CI= 0.71, 0.97) in death or dependency by the end of scheduled follow up as compared to general medical wards.

Conclusion: There is evidence from 1 meta-analysis that comprehensive stroke units are effective in reducing death or dependency by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Death or institutional care by the end of scheduled follow upEffective1

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of comprehensive stroke units and revealed a reduction (OR= 0.80, 95% 0.70, 0.92) in death or institutional care by the end of scheduled follow up as compared to general medical wards.

Conclusion: There is evidence from 1 meta-analysis that comprehensive stroke units are effective in reducing death or institutional care by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Length of stay (days) in a hospital or institutionEffective1

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of organized stroke care and revealed that comprehensive stroke units reduce length of stay compared to general medical wards (SMD= -0.19, 95% CI= -0.31, -0.06).

Conclusion: There is evidence from a meta-analysis that comprehensive stroke units are effective in reducing length of stay as compared to general medical wards in patients with stroke.

Mixed rehabilitation ward vs. general medical ward

Death by the end of scheduled follow upNot effective4

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of organized stroke care and revealed a reduction (OR= 0.91, 95% CI= 0.58, 1.42) in death by the end of scheduled follow up for mixed rehabilitation wards as compared to general medical wards. However, the effect was not statistically significant.

Conclusion: There is evidence from 1 meta-analysis that mixed rehabilitation wards are not effective in reducing death by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Death or dependency by the end of scheduled follow upEffective1

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of organized stroke care and revealed a reduction (OR= 0.65, 95% CI= 0.47, 0.90) in death or dependency by the end of scheduled follow up for mixed rehabilitation wards as compared to general medical wards.

Conclusion: There is evidence from a meta-analysis that mixed rehabilitation wards are effective in reducing death or dependency by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Death or institutional care by the end of scheduled follow upEffective1

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of organized stroke care and revealed a reduction (OR= 0.71, 95% CI= 0.51, 0.99) in death or institutional care by the end of scheduled follow up for mixed rehabilitation wards as compared to general medical wards.

Conclusion: There is evidence from 1 meta-analysis that mixed rehabilitation wards are effective in reducing death or institutional care by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Length of stay (days) in a hospital or institutionNot effective4

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of mixed rehabilitation wards and revealed no effect on length of stay (days) in a hospital or institution as compared to general medical wards (SMD= 0.08, 95% CI= -0.21, 0.37).

Conclusion: There is evidence from a meta-analysis that mixed rehabilitation wards are not effective in reducing length of stay (days) in a hospital or institution as compared to general medical wards in patients with stroke.

Mobile stroke team vs. general medical ward

Death by the end of scheduled follow upNot effective4

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of organized stroke care and revealed that mobile stroke teams do not reduce death by the end of scheduled follow up as compared to general medical wards (OR= 1.03, 95% 0.74, 1.42).

Conclusion: There is evidence from a meta-analysis that mobile stroke teams are not effective for reducing death by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Death or dependency by the end of scheduled follow upNot effective4

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of organized stroke care and revealed that mobile stroke teams do not reduce death or dependency by the end of scheduled follow up as compared to general medical wards (OR= 0.96, 95% 0.69, 1.34).

Conclusion: There is evidence from a meta-analysis that mobile stroke teams are not effective in reducing death or dependency by the end of scheduled follow up compared to general medical wards in patients with stroke.

Death or institutional care by the end of scheduled follow upNot effective4

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of organized stroke care and revealed that mobile stroke teams do not reduce death or institutional care by the end of scheduled follow up as compared to general medical wards (OR= 1.16, 95% 0.84, 1.60).

Conclusion: There is evidence from a meta-analysis that mobile stroke teams are not effective in reducing death or institutional care by the end of scheduled follow up as compared to general medical wards in patients with stroke.

Length of stay (days) in a hospital or institutionNot effective4

meta-analysis (Stroke Unit Trialists` Collaboration, 2007) investigated the effectiveness of organized stroke care and revealed that mobile stroke teams do not reduce length of stay (days) in a hospital or institution as compared to general medical wards (SMD=  -0.04, 95% -0.67, 0.59).

Conclusion: There is evidence from a meta-analysis that mobile stroke teams are not effective in reducing length of stay (days) in a hospital or institution as compared to general medical wards in patients with stroke.