Foley Norine, Salter Katherine, Teasell Robert
Department of Physical Medicine, Parkwood Hospital, St. Joseph's Health Care London, London, Ont., Canada.
Cerebrovasc Dis. 2007;23(2-3):194-202. doi: 10.1159/000097641. Epub 2006 Dec 1.
Using previously published data, the purpose of this study was to identify and discriminate between three different forms of inpatient stroke care based on timing and duration of treatment and to compare the results of clinically important outcomes.
Randomized controlled trials, including a recent review of inpatient stroke unit/rehabilitation care, were identified and grouped into three models of care as follows: (a) acute stroke unit care (patients admitted within 36 h of stroke onset and remaining for up to 2 weeks; n = 5), (b) units combining acute and rehabilitative care (combined; n = 4), and (c) rehabilitation units where patients were transferred onto the service approximately 2 weeks following stroke (post-acute; n = 5). Pooled analyses for the outcomes of mortality, combined death and dependency and length of hospital stay were calculated for each model of care, compared to conventional care.
All three models of care were associated with significant reductions in the odds of combined death and dependency; however, acute stroke units were not associated with significant reductions in mortality when this outcome was analyzed separately (OR 0.80; 95% CI: 0.61-1.03). Post-acute stroke units were associated with the greatest reduction in the odds of mortality (OR 0.60; 95% CI: 0.44-0.81). Significant reductions in length of hospital stay were associated with combined stroke units only (weighted mean difference -14 days; 95% CI: -27 to -2).
Overall, specialized stroke services were associated with significant reductions in mortality, death and dependency and length of hospital stay although not every model of care was associated with equal benefit.
本研究旨在利用先前发表的数据，根据治疗时间和持续时间识别并区分三种不同形式的住院卒中护理，并比较具有临床重要意义的结局结果。
确定了随机对照试验，包括最近对住院卒中单元/康复护理的综述，并将其分为以下三种护理模式：(a) 急性卒中单元护理（卒中发作后36小时内入院并停留长达2周；n = 5），(b) 急性和康复护理相结合的单元（联合；n = 4），以及 (c) 卒中后约2周将患者转至该服务的康复单元（急性后；n = 5）。计算每种护理模式与传统护理相比的死亡率、死亡和依赖合并率以及住院时间结局的汇总分析。
所有三种护理模式均与死亡和依赖合并率的显著降低相关；然而，单独分析该结局时，急性卒中单元与死亡率的显著降低无关（OR 0.80；95% CI：0.61 - 1.03）。急性后卒中单元与死亡率降低幅度最大相关（OR 0.60；95% CI：0.44 - 0.81）。仅联合卒中单元与住院时间的显著缩短相关（加权平均差 -14天；95% CI：-27至-2）。
总体而言，专门的卒中服务与死亡率、死亡和依赖以及住院时间的显著降低相关，尽管并非每种护理模式都具有同等益处。
