Re: Randomized controlled study of stroke unit versus stroke team care in different stroke subtypes.

Abstract

To the Editor: We have read with interest the article by Evans et al,1 which presents a post hoc analysis of a previously published randomized controlled trial comparing a stroke unit, a stroke team, and domiciliary care.2 The demonstration that the stroke team could not provide sufficient stroke management can be considered the most important conclusion of this trial. This finding confirms our previously reported study comparing a stroke unit with a stroke team within the same neurological department, demonstrating that a stroke unit is better than the stroke team in terms of reduction of mean hospital stay, systemic and neurological complications, and hospital costs, in addition to an improvement of functional state at discharge with an increase in the number of independent patients and a decrease in long-term hospitalization. Besides, we also demonstrated that cerebral hemorrhage and territorial infarction patients (both atherosclerotic and cardioembolic stroke subtypes) get more benefit from a neurological stroke unit care than lacunar or transient ischemic attack patients,3 a finding that could help us to optimize the stroke unit results, taking into account the limited stroke unit resources, and the preliminary data of this analysis were communicated in the 10th European Stroke Conference that took place in Lisbon, Portugal, in May 2001.4 In this report Evans et al, in a post hoc analysis of a randomized trial, found no differences in outcome in the stroke unit versus the stroke team in terms of mortality, mortality or institutionalization, level of neurological recovery, or dependence, confirming our observations about lacunar stroke. …