Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
Med Care. 2011 Aug;49(8):693-700. doi: 10.1097/MLR.0b013e318213c024.
Specialized stroke unit care improves outcome in stroke patients. However, it is uncertain whether the units should be placed in a neurological or non-neurological (eg, internal medicine or geriatric) setting.
To assess whether stroke unit setting (neurological/non-neurological) is associated with quality of care and outcome among patients with stroke, and whether these associations depend on the severity of comorbidity.
In a nationwide population-based follow-up study, we identified 45,521 patients admitted to stroke units in Denmark between 2003 and 2008. Outcomes were quality of care (whether patients received evidence-based processes of acute stroke care), mortality, length of stay, and readmission. Charlson comorbidity index was used to assess comorbidity, and comparisons were adjusted for patient and hospital characteristics.
Patients admitted to stroke units in neurological settings had higher odds for early antiplatelet therapy (odds ratio, 1.68; 95% confidence interval, 1.10-2.56) and early computed tomographic scan or magnetic resonance imaging (odds ratio, 1.77; 95% confidence interval, 1.29-2.45) compared with patients in non-neurological settings. No other differences were found when studying quality of care and patient outcomes. However, patients with moderate comorbidity admitted to stroke units in neurological settings had higher odds for 1-year mortality, but comparisons across strata of comorbidity were not statistical significant.
Except for early antiplatelet therapy and early computed tomographic scan or magnetic resonance imaging, the medical setting was not associated with differences in processes of acute stroke care and patient outcome. No medical setting related differences were found according to comorbidity, although indications of a worse outcome in patients with moderate comorbidity in neurological settings warrant further investigation.
专门的卒中单元护理可改善卒中患者的预后。然而，尚不确定卒中单元应设在神经科还是非神经科（例如，内科或老年科）环境中。
评估卒中单元环境（神经科/非神经科）与卒中患者的护理质量和预后是否相关，以及这些相关性是否取决于合并症的严重程度。
在一项全国范围内基于人群的随访研究中，我们确定了 2003 年至 2008 年期间在丹麦卒中单元住院的 45521 例患者。结局为护理质量（患者是否接受急性卒中护理的循证流程）、死亡率、住院时间和再入院率。Charlson 合并症指数用于评估合并症，比较调整了患者和医院特征。
与非神经科环境中的患者相比，在神经科环境中接受治疗的卒中患者更有可能早期接受抗血小板治疗（优势比，1.68；95%置信区间，1.10-2.56）和早期计算机断层扫描或磁共振成像（优势比，1.77；95%置信区间，1.29-2.45）。在研究护理质量和患者结局时，未发现其他差异。然而，在神经科环境中接受治疗的合并症中度的患者 1 年死亡率更高，但在合并症各分层之间的比较无统计学意义。
除了早期抗血小板治疗和早期计算机断层扫描或磁共振成像外，医疗环境与急性卒中护理流程和患者预后的差异无关。根据合并症，并未发现医疗环境相关的差异，但在神经科环境中合并症中度的患者预后较差的迹象需要进一步研究。
