Acute stroke unit care and early neurological deterioration in ischemic stroke

Objective To evaluate the impact that monitored acute stroke unit care may have on the risk of early neurological deterioration (END), and 90-day mortality and mortality-disability. Methods Non-randomized prospective study with consecutive patients with acute ischemic stroke (AIS) admitted to a conventional care stroke unit (CCSU), from May 2003 to April 2005, or to a monitored acute stroke unit (ASU) from May 2005 to April 2006. END was defined as an increase in the NIHSS score >= 4 points in the first 72 hours after admission. Results END was detected in 19.6 % of patients (11.2 % of patients admitted to the ASU and 23.8 % to the CCSU; p < 0.0001). Patients admitted to the ASU received more treatment with intravenous rtPa (13.5 % versus 4.2 %; p < 0.0001), had a shorter length of stay (9.1 [11.0] d versus 13.1 [10.4] d; p < 0.0001), lower 90-day mortality (10.2 % versus 17.3 %; p = 0.02), and lower mortality-disability at 90-days (28.4 % versus 40.2 %; p = 0.004) than those admitted to the CCSU. Multivariable analysis showed that ASU admission was a protector for END (OR: 0.37; 95 % CI: 0.23-0.62). On admission, higher NIHSS (OR: 1.06; 95 % CI: 1.03-1.10), higher glycaemia (OR: 1.003; 95 % CI: 1.001-1.006), and higher systolic pressure (OR: 1.01; 95 % CI: 1.002-1.017) were independent predictors of END. Conclusions END prevention by ASU care might be a key factor contributing to better outcome and decrease of length of stay in patients admitted to monitored stroke units.