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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Identification of stroke etiology may contribute to improve the outcome in dedicated units
Lucio D'Anna1, Gian L Gigli1, Giorgia Gregoraci2
1Neurology Clinic, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, "S. Maria della Misericordia" University Hospital, Udine, Italy.
Background:
The purpose of our study is to investigate whether stroke unit (SU) care and the utilization of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria may contribute to reduce death and disability in hospitalized patients after a first-ever ischemic stroke (IS).
Methods:
Data included in the present study were derived from our previous study on the incidence and outcome of cerebrovascular diseases in the district of Udine, performed from April 1, 2007, to March 31, 2009.
Results:
We identified 429 hospitalized first-ever IS cases, 297 of 429 (69.2%) patients were admitted to a dedicated SU and 132 of 429 (30.8%) to a general medical ward. According to the TOAST criteria, 101 of 132 first-ever ISs (76.5%) admitted to general medical wards were of undetermined (UND) etiology, whereas in only 105 of 297 (35.4%) patients admitted to the SU, the diagnosis remained UND. Multivariable analysis after propensity score matching showed that compared with general medical wards, SU care was associated with a reduced probability of being dead or highly disabled (P = .025) at the end of follow-up. Moreover, patients with an UND diagnosis had a worse 6-month case fatality (P < .0001) and also higher risk of being dead or highly disabled (P < .0001).
Conclusions:
Our study provides real-world evidence that accurate etiologic subtype classification of ISs according to TOAST criteria and SU care as opposed to general medical ward management are associated with reduction of the proportion of poor outcomes in first-ever IS patients.
