Effectiveness of establishing a dedicated acute stroke unit in routine clinical practice in Israel

Silvia Koton, Yvonne Schwammenthal, Oleg Merzeliak, Tamar Philips, Rakefet Tsabari, Bella Bruk, David Orion, Zeev Rotstein, Joab Chapman, David Tanne

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Abstract

Background: Clinical trials have demonstrated the superiority of managing acute stroke in a dedicated stroke unit over conventional treatment in general medical wards. Based on these findings, nationwide stroke unit care programs have been implemented in several countries. Objective: To assess the effect of establishing a new dedicated acute stroke unit within a department of neurology on indicators of process of care and outcome of acute stroke in a routine clinical setting in Israel. Methods: Stroke patients admitted to the Sheba Medical Center during the period March 2001 to June 2002 were included in a prospective study according to selection criteria. Data on demographics, risk factors, co-morbidities and stroke severity were collected. Indicators of process of care and outcome were assessed at hospital discharge and 30 days follow-up. Comparison between outcome variables by hospitalization ward was done using logistic regression analysis adjusting for confounders. Results: Of 616 acute stroke patients (mean age 70 years, 61% men, 84% ischemic stroke), 353 (57%) were admitted to general wards and 263 (43%) to the stroke unit. Diagnostic procedures were performed more often and the infection rate was lower in the setting of the stroke unit. Poor outcome (modified Rankin scale ≥3 or death) was present less often in patients managed in the stroke unit both at hospital discharge (adjusted odds ratio 0.5, 95% confidence interval 0.3-0.8) and at 30 day follow-up (adjusted OR 0.6, 95% CI 0.3-0.9). A Functional Independence Measure score ≤90 or death at 30 day follow-up was less frequent among patients managed in the stroke unit than in general wards (adjusted OR 0.5, 95%CI 0.2-0.8). Conclusions: Improved outcomes and higher adherence to guidelines were observed in patients treated in a stroke unit within a department of neurology. The results suggest that patients with acute stroke should have access to treatment in a dedicated stroke unit.

Original languageEnglish (US)
Pages (from-to)688-693
Number of pages6
JournalThe Israel Medical Association journal : IMAJ
Volume7
Issue number11
StatePublished - Nov 2005
Externally publishedYes

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Keywords

  • Acute stroke unit
  • Israel
  • Outcome
  • Process of care
  • Stroke

ASJC Scopus subject areas

  • Bioengineering
  • Medicine(all)

Cite this

Koton, S., Schwammenthal, Y., Merzeliak, O., Philips, T., Tsabari, R., Bruk, B., Orion, D., Rotstein, Z., Chapman, J., & Tanne, D. (2005). Effectiveness of establishing a dedicated acute stroke unit in routine clinical practice in Israel. The Israel Medical Association journal : IMAJ, 7(11), 688-693.