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In-hospital care pathways for stroke.
1University Department of Geriatric Medicine, University of Southampton, Level E (807), Southampton General Hospital, Tremona Road, Southampton, HANTS, UK, SO16 6YD. jk@1to1.org
The Cochrane Database of Systematic Reviews
|October 21, 2004
Summary
Stroke care pathways show mixed results, reducing infections and readmissions but increasing dependency. Evidence is insufficient to support routine implementation for acute stroke management.
Area of Science:
- Neurology
- Health Services Research
- Evidence-Based Medicine
Background:
- Stroke care pathways aim to organize and improve patient care based on guidelines.
- Evidence supporting the effectiveness of stroke care pathways remains unclear.
Purpose of the Study:
- To assess the effects of stroke care pathways compared to standard medical care for hospitalized acute stroke patients.
Main Methods:
- Searched multiple databases (Cochrane, MEDLINE, EMBASE, etc.) and handsearched journals for relevant studies.
- Included randomized controlled trials and non-randomized studies comparing care pathways with standard care.
- Conducted data extraction and quality assessment with independent review.
Main Results:
- Included 3 RCTs and 12 non-randomized studies; significant heterogeneity noted.
- No significant difference in death or discharge destination.
- Care pathways associated with increased dependency, reduced urinary tract infections and readmissions, and more neuroimaging.
- Randomized trials indicated lower patient satisfaction and quality of life with care pathways.
Conclusions:
- Stroke care pathways have both positive and negative effects.
- Results from non-randomized studies may be biased.
- Insufficient evidence currently supports routine implementation of stroke care pathways for acute stroke management or rehabilitation.