Gattellari Melina, Worthington John, Jalaludin Bin, Mohsin Mohammed
School of Public Health and Community Medicine, The University of New South Wales & Centre for Research, Evidence Management and Surveillance, Division of Population Health, Liverpool, New South Wales, Australia.
Stroke. 2009 Jan;40(1):10-7. doi: 10.1161/STROKEAHA.108.523548. Epub 2008 Oct 23.
In randomized trials, acute stroke units are associated with improved patient outcomes. However, it is unclear whether this evidence can be successfully translated into routine clinical practice. We aimed to determine the effect of a coordinated rollout of funding for 22 stroke units on patient outcomes in Australia.
A multicenter observational study was undertaken using health administrative data recording admissions for a primary diagnosis of ischemic stroke from July 2000 to June 2006. Analyses were stratified by hospital type (major principal referral, smaller nonprincipal referral hospitals).
We analyzed 17 659 admissions for ischemic stroke. Among major principal referral hospitals with acute stroke units, the proportion of admissions resulting in death or discharge to home was unchanged after stroke unit rollout (10.7% vs 10.6% and 44.1% vs 45.0%, respectively; P=0.37). In contrast, significant differences in discharge destination were noted across time among smaller nonprincipal referral hospitals (P<0.001). Before the rollout of stroke units, 13.8% of admissions to smaller hospitals resulted in a death, decreasing to 10.5% after stroke units were implemented. Discharges to home increased from 38.8% to 44.5%. Discharges to nursing homes decreased from 6.3% to 4.9%. Differences across time remained significant when controlling for patient demographics, comorbidities, indicators of poor prognosis, and clustering of outcomes at hospital level. Improved outcomes were observed across all ages and among patients with indicators for a poor prognosis.
This multicenter analysis of a large Australian population of hospital stroke admissions demonstrates short-term benefits from implementing stroke units in nonprincipal referral hospitals.
在随机试验中，急性卒中单元与改善患者预后相关。然而，尚不清楚这一证据能否成功转化为常规临床实践。我们旨在确定为澳大利亚22个卒中单元协调提供资金对患者预后的影响。
采用多中心观察性研究，使用健康管理数据记录2000年7月至2006年6月因缺血性卒中作为主要诊断入院的情况。分析按医院类型（主要转诊医院、较小的非主要转诊医院）分层。
我们分析了17659例缺血性卒中入院病例。在设有急性卒中单元的主要转诊医院中，卒中单元设立后导致死亡或出院回家的入院比例没有变化（分别为10.7%对10.6%和44.1%对45.0%；P=0.37）。相比之下，较小的非主要转诊医院在不同时间的出院目的地存在显著差异（P<0.001）。在卒中单元设立之前，较小医院13.8%的入院患者死亡，卒中单元实施后降至10.5%。出院回家的比例从38.8%增至44.5%。转至疗养院的比例从6.3%降至4.9%。在控制患者人口统计学特征、合并症、预后不良指标以及医院层面结局聚类的情况下，不同时间的差异仍然显著。在所有年龄段以及预后不良指标的患者中均观察到了预后改善。
这项对大量澳大利亚医院卒中入院患者的多中心分析表明，在非主要转诊医院实施卒中单元有短期益处。
