The organization of attention in acute care of strokes.: Stroke units make the difference

Introduction. The advantages of care in stroke units are known, as are those of being in neurology warn's as compared with the general medical wards, although to date there are no studies which make a comparative evaluation of the stroke team as compared with the stroke units with regard to benefits in care obtained by the patients. Patients and methods. We made a sequential analysis from the stroke register comparing three groups of patients attended during the years 1994-1996. During 1994 the patients were attended in the neurology ward by the stroke team. In 1995 an acute stroke units was set up. The criteria for inclusion or exclusion, health staff and technical resources were similar. We analysed the average stay, complications, mortality, hospital costs, functional state and destination on discharge. Results. We included 1,491 patients: 435 (1994), 529 (1995) and 527 (1996). Comparing stroke units with stroke team we observed a reduced average stay (29.5%; p < 0.001), fewer complications (47.8%; p< 0.001), better functional state on discharge (Rankin 1 <plus/minus> 2 against 2 +/- 2; p< 0.0001), increased transference to rehabilitation units (78%;p<less than> 0.001) with less long-term hospitalization (22%; NS) and a reduction in costs (up to 14.2%). There was no difference in mortality. Conclusions. The stroke units is a better system of attendance than stroke team for the management of strokes, since it reduces the average stay, hospital complications and health costs, as well as permitting a better functional state on discharge. Therefore treatment in the stroke units makes the difference in prognosis for these patients and the institutional expenses.