Education And Debate

Fortnightly Review: So stroke units save lives: where do we go from here?

BMJ 1994; 309 doi: (Published 12 November 1994) Cite this as: BMJ 1994;309:1273
  1. M Dennis,
  2. P Langhorne
  1. Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU
  1. Correspondence to: Dr Dennis.

    Summary points

    • A systematic review of randomised controlled trials found that patients with stroke treated in specialist units were less likely to die than those treated in general medical wards

    • The most obvious factors contributing to the effectiveness of stroke units are their organisation and the presence of a multidisciplinary team that is knowledgeable and enthusiastic about treating stroke

    • Treating stroke has three main components: acute care, rehabilitation, and prevention. A comprehensive stroke service therefore includes as assessment area for acute stroke, a stroke rehabilitation unit, and continuing care

    • Although the admission of patients to a defined geographical assessment area has several important advantages, it does not necessarily need more resources

    • A system is needed to identify patients who are most likely to benefit from a stroke rehabilitation unit

    • Geographically defined stroke rehabilitation units facilitate the participation of nursing staff in the rehabilitation process

    • Stroke services with a geographically defined stroke unit must develop a system for dealing with fluctuations in demand

    • An organised stroke service may reduce the cost of caring for patients with stroke in hospital

    • Stroke services should be tailored to local conditions

    Stroke is common, killing around 65 000 people each year in the United Kingdom and disabling even more.1 The only certain means of reducing this burden till now has been primary and secondary prevention, in which several interventions are effective.*RF 2-6* Therefore, the results of a recently published statistical overview7 are important because, for the first time, they provide an additional means of reducing this burden.

    All the randomised controlled trials comparing the outcome of patients with stroke cared for in a specialist stroke unit with the outcome of those cared for in general medical wards were examined and showed that patients managed in stroke units were less likely to die. Doctors are, however, …

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