Are stroke units beneficial?

Current situation

  • Stroke is the fourth largest cause of death in the UK and the biggest single cause of major disability.
  • Each year, over 130,000 people in England and Wales have a stroke, and of those about a third are likely to die.
  • Eighty per cent of hospitals in England now have stroke units, but the number of beds still needs to double to provide specialist care.
  • There has been an increase in the number of stroke units in the UK.

What is the evidence?

  • Stroke unit care is one of the most powerful interventions available to help stroke patients, even when compared with tissue plasminogen activator (Cerebrovasc Dis 2005; 20: 239-44).
  • Stroke patients who are treated in stroke units are almost 25 per cent less likely to die or suffer disability than those on conventional wards (Lancet 2007; 369: 299-305).
  • Patients should be admitted to a stroke unit as soon as possible after their stroke (Eur J Neurol 2006; 13: 250-5).
  • Research indicates that the best outcomes are obtained by starting rehabilitation following a stroke in a stroke unit (BMJ 2007; 334: 86-90).

Implications for practice

  • Guidelines have been launched by the Royal College of Physicians aiming to help primary care teams deliver effective treatment and secondary prevention to stroke patients.
  • Patients who have a stroke should be admitted, ideally to a stroke unit, and have a CT scan within 24 hours of admission.
  • The finding of the National Sentinel Stroke Audit that a third of patients are not being treated in a specialist unit contravenes guidelines, which recommend that patients be treated in specialist units.

Guidelines

  • The National Stroke Strategy for England was published by the DoH in December 2007.

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners', PasTest 2006.

Key Points

  • Stroke is the fourth most common cause of death.
  • All stroke patients should be managed in stroke units.
  • Stroke units are associated with lower mortality rates.
  • The National Stroke Strategy for England has been produced.


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