Cardiovascular and Medical Sciences Division, University of Glasgow, Glasgow, UK.
J Neurol Neurosurg Psychiatry. 2010 Dec;81(12):1301-5. doi: 10.1136/jnnp.2009.195131. Epub 2010 Jul 2.
Randomised trials indicate that organised inpatient (stroke unit) care has an important impact on patient outcomes with an absolute risk difference (ARD) of 3% for survival and 5% for returning home. However, it is unclear what impact this complex intervention actually has in routine practice. A comprehensive national dataset was used to study the impact of stroke unit implementation.
The Scottish linked discharge database was used to identify all patients admitted to hospital with an incident stroke. Analyses compared case fatality and discharge home (adjusted for age, sex, deprivation and comorbidity) for hospitals with or without a stroke unit during four consecutive study periods: 1986-1990, 1991-1995, 1996-2000 and 2001-2005.
During the study period, the percentage of admissions to hospitals that had a stroke unit increased from 0% to 87%, the 6 month case fatality decreased from 45% to 29% and discharges home increased from 46% to 59%. Adjusted ORs (95% CI) for case fatality (stroke unit versus no unit) in each study period were as follows: not calculable (no units before 1991), 0.83 (0.78-0.89), 0.90 (0.86-0.94) and 0.87 (0.82-0.91). These equate to an ARD of 3.0% over the whole study period. Equivalent data for discharge home indicated an increased odds of discharge home: not calculable, 1.23 (1.15-1.31), 1.15 (1.10-1.21) and 1.17 (1.11-1.23) with an overall ARD of 5%.
These results indicate a positive impact of a policy of stroke unit care on case fatality and discharge home. The estimated impact, after adjusting for case mix, appears very similar to that calculated using clinical trial data.
随机试验表明，组织化的住院（卒中单元）治疗对患者结局有重要影响，其生存率的绝对风险差异（ARD）为 3%，出院回家的比例为 5%。然而，目前尚不清楚这种复杂干预在常规实践中究竟有何影响。本研究使用综合国家数据集来研究卒中单元实施的影响。
使用苏格兰关联出院数据库来确定所有因卒中而住院的患者。分析比较了卒中单元实施前后四个连续研究期间（1986-1990 年、1991-1995 年、1996-2000 年和 2001-2005 年）有无卒中单元的医院的病死率和出院回家率（按年龄、性别、贫困程度和合并症进行调整）。
在研究期间，有卒中单元的医院入院比例从 0%增加到 87%，6 个月病死率从 45%降至 29%，出院回家比例从 46%增加到 59%。每个研究期间病死率（卒中单元与无单元）的调整比值比（95%CI）如下：1991 年前无单元（不可计算），0.83（0.78-0.89）、0.90（0.86-0.94）和 0.87（0.82-0.91）。这相当于整个研究期间的 ARD 为 3.0%。出院回家的等效数据表明出院回家的几率增加：不可计算，1.23（1.15-1.31）、1.15（1.10-1.21）和 1.17（1.11-1.23），总体 ARD 为 5%。
这些结果表明卒中单元治疗政策对病死率和出院回家有积极影响。在调整病例组合后，估计的影响与使用临床试验数据计算的结果非常相似。
