Zhu Hai Feng, Newcommon Nancy N, Cooper Mary Elizabeth, Green Teri L, Seal Barbara, Klein Gary, Weir Nicolas U, Coutts Shelagh B, Watson Tim, Barber Philip A, Demchuk Andrew M, Hill Michael D
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Rm 1242A, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
Stroke. 2009 Jan;40(1):18-23. doi: 10.1161/STROKEAHA.108.527606. Epub 2008 Nov 13.
Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward.
A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index.
Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30% (P<0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care.
We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.
随机试验已证明卒中单元护理可降低发病率和死亡率；然而，其对住院时间的影响以及由此产生的经济效益，尚无明确界定。2001年，我们机构开设了一个多学科卒中单元。我们观察了与入住普通神经科/内科病房相比，卒中单元是否能缩短住院时间和降低院内病死率。
利用管理数据库对卡尔加里山麓医疗中心的两个队列进行回顾性研究。我们将2001年前在普通神经科/内科病房接受治疗的一组卒中患者，与2003年后在卒中单元接受治疗的一组类似卒中患者进行比较。住院时间以7天为中心进行二分法划分，Charlson指数也进行二分法划分以进行分析。采用多变量逻辑回归比较两组患者的住院时间和病死率，并对年龄、性别以及由Charlson指数定义的患者合并症进行校正。
卒中单元患者（n = 2461）的平均住院时间为15天，而在普通神经科/内科病房接受治疗的患者（n = 1567）为19天。在普通神经科/内科病房住院时间>7天的患者比例为53.8%，而在卒中单元为44.4%（差异为9.4%；P<0.0001）。与普通神经科/内科病房相比，卒中单元住院时间>7天的校正比值降低了30%（P<0.0001）。卒中单元护理使总体院内病死率降低了4.5%。
我们观察到与普通神经科/内科病房相比，卒中单元的住院时间缩短，院内病死率降低。
