Do stroke units save lives?

• Published in: The Lancet (British edition) Vol. 342; no. 8868; pp. 395 - 398
• Main Authors: Langhorne, P., Williams, B.O., Gilchrist, W., Howie, K.
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 14.08.1993; Lancet; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cerebrovascular Disorders - mortality; Cerebrovascular Disorders - rehabilitation; Cerebrovascular Disorders - therapy; Female; Health care; Hospitals; Humans; Intensive Care Units - statistics & numerical data; Male; Medical research; Medical sciences; Mortality; Neurology; Outcome Assessment (Health Care); Patient Care Team; Patients; Patients' Rooms; Randomized Controlled Trials as Topic; Stroke; Survival Rate; Vascular diseases and vascular malformations of the nervous system; Vascular disease; Human; Nervous system diseases; Stroke; Cardiovascular disease; Statistical study; Survival; Cerebrovascular disease; Intensive care unit
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/0140-6736(93)92813-9

Management of stroke patients in specialist stroke units hastens recovery but is not believed to influence mortality. We did a statistical overview of randomised controlled trials reported between 1962 and 1993 in which the management of stroke patients in a specialist unit was compared with that in general wards. We identified 10 trials, 8 of which used a strict randomisation procedure. 1586 stroke patients were included; 766 were allocated to a stroke unit and 820 to general wards. The odds ratio (stroke unit vs general wards) for mortality within the first 4 months (median follow-up 3 months) after the stroke was 0·72 (95% Cl 0·56-0·92), consistent with a reduction in mortality of 28% (2p < 0·01). This reduction persisted (odds ratio 0·79, 95% Cl 0·63-0·99, 2p<0 05) when calculated for mortality during the first 12 months. The findings were not significantly altered if the analysis was limited to studies that used a formal randomisation procedure. We conclude that management of stroke patients in a stroke unit is associated with a sustained reduction in mortality.