Organised inpatient (stroke unit) care for stroke

 

Abstract

Background

Organised stroke unit care is provided by multidisciplinary teams that exclusively manage stroke patients in a dedicated ward (stroke, acute, rehabilitation, comprehensive), with a mobile stroke team or within a generic disability service (mixed rehabilitation ward).

Objectives

To assess the effect of stroke unit care compared with alternative forms of care for patients following a stroke.

Search methods

We searched the Cochrane Stroke Group trials register (last searched April 2006), the reference lists of relevant articles, and contacted researchers in the field.

Selection criteria

Randomised and prospective controlled clinical trials comparing organised inpatient stroke unit care with an alternative service.

Data collection and analysis

Two review authors initially assessed eligibility and trial quality. Descriptive details and trial data were then checked with the co-ordinators of the original trials.

Main results

Thirty-one trials, involving 6936 participants, compared stroke unit care with an alternative service; more organised care was consistently associated with improved outcomes. Twenty-six trials (5592 participants) compared stroke unit care with general wards. Stroke unit care showed reductions in the odds of death recorded at final (median one year) follow up (odds ratio (OR) 0.86; 95% confidence interval (CI) 0.76 to 0.98; P = 0.02), the odds of death or institutionalised care (OR 0.82; 95% CI 0.73 to 0.92; P = 0.0006) and death or dependency (OR 0.82; 95% CI 0.73 to 0.92; P = 0.001). Sensitivity analyses indicated that the observed benefits remained when the analysis was restricted to trials that used formal randomisation procedures with blinded outcome assessment. Outcomes were independent of patient age, sex or stroke severity, but appeared to be better in stroke units based in a discrete ward. There was no indication that organised stroke unit care resulted in a longer hospital stay.

Authors' conclusions

Stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke. The benefits were most apparent in units based in a discrete ward. No systematic increase was observed in the length of inpatient stay.

 

Plain language summary

Organised inpatient (stroke unit) care for stroke

Organised stroke unit care is a form of care provided in hospital by nurses, doctors and therapists who specialise in looking after stroke patients and work as a co-ordinated team. This review of 31 trials, involving 6936 participants, showed that patients who receive this care are more likely to survive their stroke, return home and become independent in looking after themselves. A variety of different types of stroke unit have been developed. The best results appear to come from those which are based in a dedicated ward.

 

摘要

背景

對於中風的整合性住院病人(中風中心)照顧

整合性中風中心的照顧是經由多專業團隊在一個專用(中風,急性,復健,整合性)的病房、由一個機動性的中風團隊，或是在一般性的失能照護服務(混合性復健病房)中，來專責處理中風病人。

目標

評估中風中心的照顧比較其他形式的照顧，對中風後病人的治療效果。

搜尋策略

我們搜尋Cochrane Stroke Group trials register(及至2006年4月)資料庫，相關論文的參考文獻，並且聯絡此領域的研究人員。

選擇標準

比較整合性中風中心與其他照護方式的隨機與前瞻性對照臨床試驗(Randomised and prospective controlled clinical trials)。

資料收集與分析

兩位檢閱者首先評估納入資格與試驗品質。然後他們與試驗主持人核對描述性細節與試驗資料。

主要結論

囊括6936位參與者的31個試驗比較中風中心與其他照護方式的差別：更整合性的的照顧一致地能夠改善預後。26個試驗(共5592位參與者)比較中風中心與一般病房。中風中心的照顧顯示能減少在追蹤期末了(中位數1年)的死亡率(odds ratio(OR) .86; 95% confidence interval(CI) 0.76 to 0.98; P = 0.02)，死亡率或需機構照護的勝算比(OR 0.82; 95% CI 0.73 to 0.92; P = 0.0006)，以及病患為死亡或依賴照護的勝算比(OR 0.82; 95% CI 0.73 to 0.92; P = 0.001)。敏感度分析(Sensitivity analyses)指出，即使只侷限於分析使用正式隨機程序與盲性預後評估的試驗，仍然有治療的效益存在。預後與病人年齡、性別或中風嚴重度無關，但是在設置於單獨病房的中風中心裡較好。沒有跡象顯示中風中心的照顧會延長住院時間。

作者結論

中風病人在中風中心接受整合性的住院照顧較能夠存活、獨立生活並且中風後一年較能住在家中。在設置於單獨病房的中風中心此種效益最為顯著。在住院日數上並未發現系統性的增加。

翻譯人

本摘要由奇美醫院陳軾正翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於中風的整合性住院病人(中風中心)照顧。 整合性中風中心的照顧是一種在醫院中經由專門照顧中風病人的護士、醫師與治療師合作的團隊來提供的照顧。這篇回顧31個試驗囊括6936位參與者的論文，顯示病人接受此種照顧較可能在中風之後存活、返家並且獨立照顧自己。有多種不同形式的中風中心已被發展出來。其中最好的結果顯示是來自於建立在專責病房內的中風中心。