Rudd A G, Hoffman A, Irwin P, Lowe D, Pearson M G
Stroke Programme, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians London, Guys and St Thomas' Hospitals NHS Trust London.
Stroke. 2005 Jan;36(1):103-6. doi: 10.1161/01.STR.0000149618.14922.8a. Epub 2004 Nov 29.
Stroke unit care is one of the most powerful interventions available to help stroke patients. There are limited data available to assess the impact of stroke units in routine clinical practice outside randomized clinical trials. This article uses data from the 2001 to 2002 National Stroke Audit to assess the effectiveness of stroke unit care in England, Wales, and Northern Ireland in delivering effective processes of care and in reducing case fatality and disability.
An observational study of the organization, structure, process of care, and outcomes for stroke in 2001. Case fatality after stroke in England was compared using data from the audit and routinely collected data from the Department of Health. 240 hospitals (196 Trusts) from England, Wales, and Northern Ireland took part in the 2001 to 2002 National Stroke Audit, a response rate of >95%. These sites assessed a total of 8200 patients using the Royal College of Physicians Intercollegiate Working Party Stroke Audit Tool.
The availability of stroke unit care varies hugely across the country. Case fatality after stroke was higher in Trusts with least availability of stroke unit care. These differences persisted after control for case mix. The process of care was better for patients managed on stroke units compared with other settings. Overall, the risk of death for patients who received stroke unit care was estimated to be approximately 75% that of the risk for those having no stroke unit care (95% CI, 60 to 90).
Stroke unit care as provided in routine clinical practice in England, Wales, and Northern Ireland reduces case fatality by approximately 25%, which is in line with the figures obtained from systematic analysis of stroke unit trial data.
卒中单元护理是帮助卒中患者的最有效干预措施之一。在随机临床试验之外，用于评估卒中单元在常规临床实践中影响的数据有限。本文利用2001年至2002年全国卒中审计的数据，评估英格兰、威尔士和北爱尔兰的卒中单元护理在提供有效护理流程以及降低病死率和残疾率方面的有效性。
对2001年卒中的组织、结构、护理流程及结局进行观察性研究。利用审计数据和卫生部常规收集的数据，比较英格兰卒中后的病死率。来自英格兰、威尔士和北爱尔兰的240家医院（196个信托机构）参与了2001年至2002年全国卒中审计，回应率超过95%。这些机构使用皇家内科医师学院跨学院工作组卒中审计工具共评估了8200例患者。
卒中单元护理的可及性在全国差异巨大。卒中单元护理可及性最低的信托机构中，卒中后的病死率更高。在对病例组合进行控制后，这些差异依然存在。与其他环境下的患者相比，在卒中单元接受治疗的患者护理流程更佳。总体而言，接受卒中单元护理的患者死亡风险估计约为未接受卒中单元护理患者风险的75%（95%可信区间，60至90）。
英格兰、威尔士和北爱尔兰常规临床实践中提供的卒中单元护理可使病死率降低约25%，这与对卒中单元试验数据进行系统分析得出的数字一致。
