Importance of stroke units

Current situation

  • Stroke is the fourth most common 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 will die; the rest will make a recovery or will be left disabled and need rehabilitation from specialist services.
  • In England, 80 per cent of hospitals now have stroke units, but the number of beds will have to double in order to provide specialist care for all patients.
  • Despite an increase in the number of stroke units after targets were set by the NSF for older people, a third of stroke patients are still being cared for on general wards for most of their hospital stay.

What is the evidence?

  • Stroke unit care is one of the most powerful interventions available for stroke patients, even when compared with tissue plasminogen activator  treatment (Cerebrovasc Dis 2005; 20: 239).
  • The risk of death for patients who received stroke unit care has been estimated to be approximately 75 per cent of the risk for those who do not receive stroke unit care (Stroke 2005; 36: 103).
  • Stroke patients treated in stroke units are almost 25 per cent less likely to die or suffer disability than those on conventional wards, according to a recent observational study (Lancet 2007; 369: 299–305).
  • Patients should ideally be admitted to a stroke unit as soon as possible after their stroke. One study showed that admission within three hours improved outcome and reduced disability at three months (Eur J Neurol 2006; 13: 250–5).

Implications for practice

  • Guidelines have been published by the Royal College of Physicians with the aim of helping primary care teams deliver effective treatment and secondary prevention to stroke patients.
    The guidelines include the importance of admission to a specialist stroke unit.
  • Patients who have a stroke should be admitted, ideally to a stroke unit, and have a CT scan within 24 hours of admission.

Further reading

  • The RCP Primary Care Concise Guidelines are based on the updated National Clinical Guidelines for Stroke, published in July 2004.

Useful websites —Royal College of Physicians — The UK Stroke Association
www.healthcarecommission. — The report Survey of Patients 2005: Stroke

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