Seenan Pamela, Long Marita, Langhorne Peter
Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, UK.
Stroke. 2007 Jun;38(6):1886-92. doi: 10.1161/STROKEAHA.106.480871. Epub 2007 Apr 26.
Within clinical trials, stroke patients allocated to receive organized inpatient (stroke unit) care are more likely to survive, return home, and regain independence than those allocated to conventional care. However, there are concerns that the benefits seen in clinical trials may not be replicated in routine practice. We carried out a systematic review of observational studies of stroke unit implementation.
We searched (up to January 2006) MEDLINE, EMBASE, CINAHL, Cochrane Library, British Nursing Index, Cochrane Stroke Group register, and recent conference abstracts for observational studies that compared the outcomes of stroke patients managed in a stroke unit versus non-stroke unit care. We excluded studies that did not describe either matching for baseline prognostic factors or adjustment for case-mix characteristics. The primary outcome was death within 1 year. We also recorded poor outcome (death, institutional care, or dependency). Data analysis used the generic inverse variance method in Revman 4.2. Where raw data were provided, effect sizes and variances were calculated accordingly. We used a random-effects model and explored for sources of heterogeneity.
We identified 72 articles describing stroke unit outcomes; 25 were eligible for review; and 18 provided data on case fatality or poor outcome. Stroke unit care was associated with significantly reduced odds of death (odds ratio=0.79, 95% CI=0.73 to 0.86; P<0.00001) and of death or poor outcome (odds ratio=0.87, 95% CI=0.80 to 0.95; P=0.002) within 1 year of stroke. Results were complicated by significant heterogeneity (P<0.05), mainly in single-center studies.
Although these results are complicated by potential bias and heterogeneity, the observed benefit associated with stroke unit care in routine practice is comparable to that in clinical trials.
在临床试验中，与接受传统治疗的中风患者相比，被分配接受有组织的住院（中风单元）治疗的中风患者存活、回家以及恢复独立生活的可能性更大。然而，有人担心临床试验中所见到的益处可能无法在常规医疗实践中重现。我们对中风单元实施的观察性研究进行了系统评价。
我们检索了（截至2006年1月）MEDLINE、EMBASE、CINAHL、Cochrane图书馆、英国护理索引、Cochrane中风小组登记册以及近期会议摘要，以查找比较在中风单元接受治疗与未在中风单元接受治疗的中风患者结局的观察性研究。我们排除了未描述对基线预后因素进行匹配或对病例组合特征进行调整的研究。主要结局为1年内死亡。我们还记录了不良结局（死亡、机构护理或依赖）。数据分析使用Revman 4.2中的通用逆方差法。若提供了原始数据，则相应计算效应量和方差。我们使用随机效应模型并探究异质性来源。
我们识别出72篇描述中风单元结局的文章；25篇符合综述条件；18篇提供了关于病死率或不良结局的数据。中风单元护理与中风后1年内死亡几率（优势比=0.79，95%可信区间=0.73至0.86；P<0.00001）以及死亡或不良结局几率（优势比=0.87，95%可信区间=0.80至0.95；P=0.002）的显著降低相关。结果因显著的异质性（P<0.05）而变得复杂，主要存在于单中心研究中。
尽管这些结果因潜在偏倚和异质性而变得复杂，但在常规医疗实践中观察到的与中风单元护理相关的益处与临床试验中的相当。
