The evolution of stroke units-towards a more intensive approach?

Abstract

The last five to ten years have seen an intensive research effort to find novel treatments for acute stroke with many more large trials of thrombolytic1,,2 and neuroprotective agents.3,,4 Unfortunately, none of these treatments have proven effective enough to recommend routine use in acute stroke. Although results from thrombolysis trials are promising,1,,2 uncertainty persists about more widespread usage, and it is likely that only a small proportion of stroke patients will ever be eligible for treatment because of the short time window for triage and treatment.5,,6 Perhaps the most significant advance in stroke management therefore has not been pharmacological, but concerns the process of care for stroke patients, with convincing evidence that changing the approach to the way stroke patients are managed has a beneficial impact on both mortality and morbidity.7 The concept of organized care on geographically‐defined units has given rise to a more disease‐specific approach to the management of stroke. In practical terms, this has cut across the more generic approach to general medical admissions within acute hospitals, particularly in the UK, and creation of stroke units often requires a substantial reorganization of beds within hospitals. This article aims to define which aspects of stroke unit care make the difference and how the process of care for stroke patients may evolve further in the future. In 1993, results from all existing randomized controlled trials comparing the outcome of patients managed in defined stroke units with outcomes from conventional settings of care were examined in a meta‐analysis.8 This showed that care on a stroke unit reduced mortality by 28% and also reduced the risk of patients requiring institutionalized care at a median of 12 months after stroke. Subsequently, the Stroke Unit Trialists' Collaboration within the …