The Stroke Unit Benefit for Improved Diagnostics in Patients with Cerebro-Vascular Accidents

Authors: R. Herzig 1;  I. Vlachová 1;  B. Křupka 1;  D. Šaňák 1;  A. Bártková 1;  J. Mareš 1;  D. Školoudík 1;  M. Král 1;  J. Zapletalová 2;  P. Kaňovský 1
Authors‘ workplace: Neurologická klinika LF UP a FN Olomouc 1;  Pracoviště biometrie, Ústav lékařské biofyziky, LF UP a FN Olomouc 2
Published in: Cesk Slov Neurol N 2007; 70/103(3): 272-276
Category: Short Communication


The stroke unit (SU) care has been shown to improve diagnostics and treatment, resulting in better clinical outcome in stroke patients.

Patients and methods:
In a retrospective, hospital-based study, the availability of diagnostic methods for stroke patients was assessed in 205 patients treated after the opening of a SU, and in a control group of 300 patients treated prior to the opening of a SU at the Department of Neurology, University Hospital, Olomouc, Czech Republic. The availability of the following diagnostic methods was observed: brain computerized tomography (CT), ultrasonography (US) of the extracranial brain arteries, X-ray of the chest, electrocardiogram (ECG) incl. ECG-monitoring, and laboratory screening. The homogeneity χ2 test was applied when assessing statistical significance.

The following availability of particular diagnostic methods after versus prior to the SU opening was observed – since the admission within 24 hours/after 24 hours/not performed: brain CT 96.1% / 1.5% / 2.4% versus 23.3% / 25.7% / 51.0%; extracranial brain arteries US 26.4% / 39.1% / 34.5% versus 3.7% / 31.0% / 65.3%; X-ray of the chest 74.6% / 14.7% / 10.7% versus 30.7% / 53.3% / 16.0%; ECG incl. ECG-monitoring 96.1% / 0% / 3.9% versus 0% / 0% / 100%; laboratory screening – since the admission complete within 24 hours / partial / not performed 100% / 0% / 0% versus 3% / 96.3% / 0.7% (p < 0.0001 in all cases).

The SU care significantly improved acute stroke diagnostics at the Department of Neurology, University Hospital, Olomouc, Czech Republic.

Key words:
stroke unit – acute stroke – diagnostics


1. Beaglehole R, Jackson R. Alcohol, cardiovascular diseases and all causes of death: a review of the epidemiological evidence. Drug Alcohol Rev 1992; 11: 275-90.

2. Tegos TJ, Kalodiki E, Daskalopoulou SS, Nicolaides AN. Stroke: epidemiology, clinical picture, and risk factors. Part I of III. Angiology 2000; 51: 793-808.

3. ÚZIS ČR. Hospitalizovaní a zemřelí na cévní nemoci mozku v ČR v letech 2001 – 2002. Praha: ÚZIS ČR 2004.

4. Garraway WM, Akhtar AJ, Hockey L, Prescott RJ. Management of acute stroke in the elderly: follow-up of a controlled trial. Br Med J 1980; 281: 827-9.

5. Strand T, Asplund K, Eriksson S, Hagg E, Lithner F, Wester PO. A non-intensive stroke unit reduces functional disability and the need for long-term hospitalization. Stroke 1985; 16: 29-34.

6. Strand T, Asplund K, Eriksson S, Hagg E, Lithner F, Wester PO. Stroke unit care - who benefits? Comparisons with general medical care in relation to prognostic indicators on admission. Stroke 1986; 17: 377-81.

7. Indredavik B, Bakke F, Solberg R, Rokseth R, Haheim LL, Holme I. Benefit of a stroke unit: A randomized controlled trial. Stroke 1991; 22: 1026-31.

8. Langhorne P, Williams BO, Gilchrist W, Howie K. Do stroke units save lives? Lancet 1993; 342: 395-8.

9. Kalra L, Dale P, Crome P. Improving stroke rehabilitation. A controlled study. Stroke 1993; 24: 1462-7.

10. Duncan G, Ritchie LC, Jamieson DM, McLean MA. Acute stroke in South Ayrshire: comparative study of pre and post stroke units. Health Bull (Edinb) 1995; 53: 159-66.

11. Langhorne P, Williams BO, Gilchrist W, Dennis MS, Slattery J. A formal overview of stroke unit trials. Rev Neurol 1995; 23: 394-8.

12. Jorgensen HS, Nakayama H, Raaschou HO, Larsen K, Hubbe P, Olsen TS. The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost. A community-based study. Stroke 1995; 26: 1178-82.

13. Bath PMW, Soo J, Butterworth RJ, Kerr JE. Do acute stroke units improve care? Cerebrovasc Dis 1996; 6: 346-9.

14. Hinkle JL, Forbes E. Pilot project on functional outcome in stroke. J Neurosci Nurs 1996; 28: 13-8.

15. Stroke Unit Trialists´ Collaboration. Collaborative systematic review of the randomised trials of organised in-patient (stroke unit) care after stroke. Br Med J 1997; 314: 1151-9.

16. Berlit P, Popescu O, Kloetzsch C, Diehl RR, Berg-Dammer E. Behandlung des akuten Schlaganfalls auf der Stroke Unit. Nervenarzt 1997; 68: 122-8.

17. Indredavik B, Slordahl SA, Bakke F, Rokseth R, Haheim LL. Stroke unit treatment long-term effects. Stroke 1997; 28: 1861-6.

18. Stroke Unit Trialists´ Collaboration. How do stroke units improve patient outcomes? A collaborative systematic review of the randomized trials. Stroke 1997; 28: 2139-44.

19. Ronning OM, Guldvog B. Stroke unit versus general medical wards, I: Twelve- and eighteen-month survival: A randomized, controlled trial. Stroke 1998; 29: 58-62.

20. Ronning OM, Guldvog B. Stroke unit versus general medical wards, II: Neurological deficits and activities of daily living: A quasi-randomized controlled trial. Stroke 1998; 29: 586-90.

21. Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL. Stroke unit treatment improves long-term quality of life: A randomized controlled trial. Stroke 1998; 29: 895-9.

22. Stegmayr B, Asplund K, Hulter-Asberg K, Norrving B, Peltonen M, Terént A, et al., for the Riks-Stroke Collaboration. Stroke units and their natural habitat. Can results of randomized trials be reproduced in routine clinical practice? Stroke 1999; 30: 709-14.

23. Treib J, Grauer MT, Woessner R, Morgenthaler M. Treatment of stroke on an intensive stroke unit: a novel concept. Intensive Care Med 2000; 26: 1598-611.

24. Kalra L, Evans A, Perez I, Knapp M, Donaldson N, Swift CG. Alternative strategies for stroke care: a prospective randomised controlled trial. Lancet 2000; 356: 894-9.

25. Cabral NL, Moro C, Silva GR, Scola RH, Werneck LC. Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil. Arq Neuropsiquiatr 2003; 61: 188-93.

26. Ma RH, Wang YJ, Qu H, Yang ZH. Assessment of the early effectiveness of a stroke unit in comparison to the general ward. Chin Med J (Engl) 2004; 117: 852-5.

27. Di Matteo M, Anderson C, Ratnasabapathy Y, Green G, Tryon K. The Acute Stroke Unit at Middlemore Hospital: an evaluation in its first year of operation. N Z Med J 2004; 117: U798.

28. Cadilhac DA, Ibrahim J, Pearce DC, Ogden KJ, McNeill J, Davis SM, et al.; SCOPES Study Group. Multicenter comparison of processes of care between Stroke Units and conventional care wards in Australia. Stroke 2004; 35: 1035-40.

29. Kalra L, Evans A, Perez I, Knapp M, Swift C, Donaldson N. A randomised controlled comparison of alternative strategies in stroke care. Health Technol Assess 2005; 9: 1-94.

30. Rudd AG, Hoffman A, Irwin P, Lowe D, Pearson MG. Stroke unit care and outcome: results from the 2001 National Sentinel Audit of Stroke (England, Wales, and Northern Ireland). Stroke 2005; 36: 103-6.

31. Hacke W, Kaste M, Skyhoj Olsen T, Orgogozi JM, Bogousslavsky J; European Stroke Initiative Writing Committee. European Stroke Initiative (EUSI) recommendations for stroke management. The European Stroke Initiative Writing Committee. Eur J Neurol 2000; 7: 607-23.

32. Krespi Y, Gurol ME, Coban O, Tuncay R, Bahar S. Stroke unit versus neurology ward – a before and after study. J Neurol 2003; 25: 1363-9.

33. Bereczki D, Csiba L, Fulesdi B, Fekete I. Stroke units in Hungary - the Debrecen experience. Cerebrovasc Dis 2003; 15 Suppl 1:23-5.

34. Jarman B, Aylin P, Bottle A. Acute stroke units and early CT scans are linked to lower in-hospital mortality rates. BMJ 2004; 328: 369.

35. Sulter G, Elting JW, Langedijk M, Maurits NM, De Keyser J. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit: a randomized pilot study. Stroke 2003; 34: 101-4.

36. Cavallini A, Micieli G, Marcheselli S, Quaglini S. Role of monitoring in management of acute ischemic stroke patients. Stroke 2003; 34: 2599-603.

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