Stroke units in the Philippines: An observational study.

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Stroke management in high-income countries has advanced with thrombolysis and endovascular treatments.
• Low-income countries face challenges with treatment availability and patient access within therapeutic time windows.
• Limited multicenter data exists on stroke unit effectiveness in Southeast Asia.

Purpose of the Study:

• To compare outcomes of stroke patients admitted to stroke units versus general neurology wards in the Philippines.
• To provide local, large-scale data on stroke unit efficacy in a Southeast Asian context.

Main Methods:

• An open, prospective, parallel, observational comparative study involving 1025 patients across 11 Philippine institutions.
• Patient allocation to stroke units or general neurology wards was based on established criteria.
• Primary outcome: in-hospital mortality at 3 and 6 months. Secondary outcome: functional status using the modified Rankin Scale (mRS).

Main Results:

• Stroke unit patients had significantly lower mortality rates at 3 months (1.0% vs 8.4%) and 6 months (0.8% vs 3.1%) compared to general neurology ward patients.
• Independent functional outcomes (mRS 0-2) were better in stroke units (73% vs 61.5%) at discharge.
• Improved functionality at 6 months was observed in stroke unit patients (88.5% vs 81.4%).

Conclusions:

• Admission to a stroke unit, based on established criteria, leads to superior outcomes for stroke patients in the Philippines.
• Specialized stroke care demonstrably improves survival and functional recovery in this Southeast Asian population.
• Findings support the implementation and expansion of stroke units in similar healthcare settings.