Beneficial effects of a semi-intensive stroke unit are beyond the monitor.

Détails

ID Serval
serval:BIB_036E73257DAD
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Beneficial effects of a semi-intensive stroke unit are beyond the monitor.
Périodique
Cerebrovascular Diseases
Auteur⸱e⸱s
Cereda C.W., George P.M., Pelloni L.S., Gandolfi-Decristophoris P., Mlynash M., Biancon Montaperto L., Limoni C., Stojanova V., Malacrida R., Städler C., Bassetti C.L.
ISSN
1421-9786 (Electronic)
ISSN-L
1015-9770
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
39
Numéro
2
Pages
102-109
Langue
anglais
Résumé
BACKGROUND AND PURPOSE: Precise mechanisms underlying the effectiveness of the stroke unit (SU) are not fully established. Studies that compare monitored stroke units (semi-intensive type, SI-SU) versus an intensive care unit (ICU)-based mobile stroke team (MST-ICU) are lacking. Although inequalities in access to stroke unit care are globally improving, acute stroke patients may be admitted to Intensive Care Units for monitoring and followed by a mobile stroke team in hospital's lacking an SU with continuous cardiovascular monitoring. We aimed at comparing the stroke outcome between SI-SU and MST-ICU and hypothesized that the benefits of SI-SU are driven by additional elements other than cardiovascular monitoring, which is equally offered in both care systems.
METHODS: In a single-center setting, we compared the unfavorable outcomes (dependency and mortality) at 3 months in consecutive patients with ischemic stroke or spontaneous intracerebral hemorrhage admitted to a stroke unit with semi-intensive monitoring (SI-SU) to a cohort of stroke patients hospitalized in an ICU and followed by a mobile stroke team (MST-ICU) during an equal observation period of 27 months. Secondary objectives included comparing mortality and the proportion of patients with excellent outcomes (modified Rankin Score (mRS) 0-1). Equal cardiovascular monitoring was offered in patients admitted in both SI-SU and MST-ICU.
RESULTS: 458 patients were treated in the SI-SU and compared to the MST-ICU (n = 370) cohort. The proportion of death and dependency after 3 months was significantly improved for patients in the SI-SU compared to MST-ICU (p < 0.001; aOR = 0.45; 95% CI: 0.31-0.65). The shift analysis of the mRS distribution showed significant shift to the lower mRS in the SI-SU group, p < 0.001. The proportion of mortality in patients after 3 months also differed between the MST-ICU and the SI-SU (p < 0.05), but after adjusting for confounders this association was not significant (aOR = 0.59; 95% CI: 0.31-1.13). The proportion of patients with excellent outcome was higher in the SI-SU (59.4 vs. 44.9%, p < 0.001) but the relationship was no more significant after adjustment (aOR = 1.17; 95% CI: 0.87-1.5).
CONCLUSIONS: Our study shows that moving from a stroke team in a monitored setting (ICU) to an organized stroke unit leads to a significant reduction in the 3 months unfavorable outcome in patients with an acute ischemic or hemorrhagic stroke. Cardiovascular monitoring is indispensable, but benefits of a semi-intensive Stroke Unit are driven by additional elements beyond intensive cardiovascular monitoring. This observation supports the ongoing development of Stroke Centers for efficient stroke care.
Mots-clé
Adolescent, Adult, Aged, Aged, 80 and over, Brain Ischemia/complications, Brain Ischemia/mortality, Case-Control Studies, Cerebral Hemorrhage/complications, Cerebral Hemorrhage/mortality, Cohort Studies, Female, Hospital Units, Humans, Intensive Care Units, Male, Middle Aged, Outcome Assessment (Health Care), Retrospective Studies, Stroke/etiology, Stroke/mortality, Young Adult
Pubmed
Création de la notice
16/03/2016 18:11
Dernière modification de la notice
20/08/2019 12:25
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