Differences of Mortality and Dependence Between Stroke Unit and General Ward Care in Acute Ischemic Stroke Patients

J Korean Neurol Assoc > Volume 27(2); 2009 > Article

Journal of the Korean Neurological Association 2009;27(2): 116-122.

급성 뇌경색 환자에서 뇌졸중치료실과 일반병동 치료 후 사망률과 의존성의 차이

고영채, 한문구 김욱주 권오기a 오창완a 정철규b 백남종c 배희준

분당서울대학교병원 뇌졸중센터 신경과, 신경외과a, 영상의학과b, 재활의학과c

Differences of Mortality and Dependence Between Stroke Unit and General Ward Care in Acute Ischemic Stroke Patients

Youngchai Ko

Departments of Neurology, Neurosurgerya, Radiologyb and Rehabilitation Medicinec, Seoul National University College of Medicine, Stroke Center, Seoul National University Bundang Hospital, Seongnam, Korea

Abstract

Background: There is strong evidence for the efficacy of stroke unit (SU) care, which has become a common practice in other developed countries but is available only in a small number of centers in Korea. This late introduction of SU care in Korea can be at least partly attributed to doubts about its benefits on patient outcomes compared to general ward (GW) care in our routine practice.
Methods: Based on a prospective stroke registry, we identified 1,300 acute stroke patients hospitalized in either SUs (n=195) or GWs (n=1,105) from January 2004 to June 2008. Clinical outcomes such as fatality and disability rates were compared using propensity score matching in the total cohort. Additional statistical adjustments were performed using stepwise logistic regression analyses with the backward elimination method for potential confounders.
Results: The baseline characteristics did not differ significantly between patients admitted to SUs (n=195) and their matched controls (n=386). The 3-month dependency rate was 17.4% in SUs and 21.0% in GWs (p=0.31), and the case fatality rates were 1.5% and 8.0% (p<0.001), respectively. Adjusted odds ratios for SU care were 0.49 for dependency (95% confidence interval [CI]=0.22-1.08) and 0.17 for death (95% CI=0.04-0.83).
Conclusions: This study showed that SU care reduces fatality rates and improves functional outcomes, which indicates the need to implement more SUs in Korea. Key Words: Stroke unit, Outcome, Mortality, Stroke