التفاصيل البيبلوغرافية
| العنوان: |
P1. Impact of implementation of a new semi-intensive stroke unit (SU) versus a mobile stroke team system – A prospective study within the Neurocentro (NSI) of Southern Switzerland |
| المؤلفون: |
Cereda, C.W.1, Städler, C.1, Andreotti, J.1, Pelloni, L.1, Frangi, J.1, Pifferini, V.1, Bassetti, C.1 |
| المصدر: |
Clinical Neurophysiology. Oct2012, Vol. 123 Issue 10, pe101-e101. 1p. |
| مصطلحات موضوعية: |
*STROKE, *LONGITUDINAL method, *CLINICAL trials, *REHABILITATION, *DEMENTIA, *LIFE expectancy |
| مصطلحات جغرافية: |
SWITZERLAND |
| مستخلص: |
Introduction: The effectiveness of stroke unit (SU) concept, understood as a place geographically organized and dedicated to patients with acute stroke and with dedicated staff, is given by the meta-analysis of more than 10 clinical trials and observational studies. The precise mechanisms that underlie the effectiveness of the SU, measured in terms of clinical outcome and mortality, remain partly controversial and not fully established. It appears that most of the studies included comparisons between dedicated unit to stroke (without cardiovascular monitoring) compared to ward care in departments of general medicine or general medicine with rehabilitation. Studies that compare monitored stroke unit (semi-intensive type) versus non-monitored structures are lacking. Methods: The study is a prospective cohort study, designed with “before-after” approach to observe the functional outcome, in terms of dependence (defined as mRankin>2) and 3-month mortality in patients diagnosed with ischemic stroke or TIA consecutively admitted in a new Stroke Unit with semi-intensive monitoring with dedicated specialized staff for a limited period of activity (after period). The results will be compared with a retrospective cohort of patients hospitalized in the period before the start of the new stroke unit (2008–2009year, the before period). Any patient admitted in the first 48h to the Stroke Unit of Neurocentro (EOC) diagnosed with acute cerebrovascular ischemic event (AIE, stroke or TIA) or Spontaneuous Intracerebral Hemorrage (ICH) will be included. Patients already institutionalized or severely disabled (mRankin>3) before the stroke or with preexisting dementia, severe co-morbidity (with life expectancy <12months) are excluded from analysis. Preliminary results: A direct comparison of mortality 3months after stroke showed a remarkable difference with 6.4% (14 out of 217) in the group after and 11.5% in the group before (34 out of 296, p =0.065nS). After adjustment for age, stroke severity (NIHSS score), sex and stroke type, the risk of mortality was shown to be reduced in the phase after (OR 2.31, p =0.023). A direct comparison 3months after stroke showed higher percentage of dependent patients in the group before with 30.4% (90 out of 296) against 25.8% in the period after (56 out of 217). TIA was found to reduce the risk of dependence compared to ischemic stroke (p =0.013), while for hemorragic stroke the risk is higher (p <0.001). After adjustment for these confounders as well as age, sex and NIHSS, there was no significant difference in the groups before and after (OR 1.53, p =0.095nS). Conclusions: Preliminary results suggest that a monitored geographically delimited stroke unit concept, compared to a mobile stroke service, may reduce 3months mortality and disability in patients suddering from acute ischemic stroke, TIA or ICH. [Copyright &y& Elsevier] |
| قاعدة البيانات: |
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