A stroke unit in a district general hospital: the Greenwich experience.

Abstract

Strokes are the commonest cause of severe permanent physical disability in Britain,1 and their care consumes a considerable proportion of acute medical resources. The reported incidence in Britain varies,2 3 but 150 cases per 100 000 a year is a useful approximation for planning. In some areas about 40% of patients with stroke are admitted to hospital2-4 with some evidence that they are more physically disabled than those left at home.5 Between one-third and one-half of the patients admitted to hospital will die within the first three weeks,2 6 and of the survivors, about one-quarter will be confidently independent, one-half will be able to walk independently using an aid and have limited personal independence, and one quarter will remain heavily dependent, usually confined to bed or chair.6 7 The care of patients with stroke may be arbitrarily but use fully divided into an acute care investigative phase and a re habilitation phase. We agree with Mulley and Arie8 that this first phase is best managed in hospital. Though uncommon, treatable lesions are more likely to be recognised in hospital, and the sheer effort needed and the difficulties that arise in managing at home a semiconscious or severely paralysed patient who initially may be incontinent should be recognised. In many general hospitals patients with stroke are admitted under the care of general physicians, and this acute care/investigative phase is accepted as being part of general medicine and is dealt with competently. The level of interest in the rehabili tation phase is unfortunately likely to be lower. As the hard