Alternative strategies for stroke care: a prospective randomised controlled trial

Area of Science:

• Neurology
• Public Health
• Healthcare Management

Background:

• Organized specialist stroke care improves patient outcomes.
• The comparative effectiveness of different stroke care organization models remains unclear.
• This study evaluates stroke units versus stroke teams and domiciliary care.

Purpose of the Study:

• To compare the efficacy of stroke unit care against stroke team support and domiciliary stroke care.
• To determine the optimal organizational model for acute stroke patient management.
• To assess the impact of care organization on patient mortality, institutionalization, and functional independence.

Main Methods:

• A single-blind, randomized controlled trial involving 457 acute stroke patients.
• Patients were allocated to either a stroke unit, general wards with stroke team support, or domiciliary stroke care within 72 hours of onset.
• Outcomes, including death or institutionalization, were assessed at 3, 6, and 12 months using an intention-to-treat analysis.

Main Results:

• Stroke unit care resulted in significantly lower rates of mortality or institutionalization at 1 year compared to stroke team (14% vs. 30%) and domiciliary care (14% vs. 24%).
• A higher proportion of patients receiving stroke unit care were alive and without severe disability at 1 year (85%) compared to stroke team (66%) or domiciliary care (71%).
• These benefits were observed consistently at 3 and 6 months post-stroke.

Conclusions:

• Stroke units demonstrate superior effectiveness in reducing mortality, institutionalization, and long-term dependence following stroke.
• Specialist stroke units provide better outcomes than general wards with stroke team support or domiciliary care.
• The findings support the implementation of dedicated stroke units for acute stroke management.