Impact of a Stroke Unit on Length of Hospital Stay and In-Hospital Case Fatality
- 1 January 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 40 (1), 18-23
- https://doi.org/10.1161/strokeaha.108.527606
Abstract
Background and Purpose— Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. Methods— A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Results— Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P7 days was reduced by 30% (PConclusions— We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.Keywords
This publication has 15 references indexed in Scilit:
- The Effects of Preexisting Medical Comorbidities on Mortality and Length of Hospital Stay in Acute Burn InjuryAnnals of Surgery, 2007
- Impact of comorbidity on ischemic stroke outcomeActa Neurologica Scandinavica, 2005
- Coding of Stroke and Stroke Risk Factors Using International Classification of Diseases , Revisions 9 and 10Stroke, 2005
- Recommendations for Comprehensive Stroke CentersStroke, 2005
- Charlson Index Comorbidity Adjustment for Ischemic Stroke Outcome StudiesStroke, 2004
- Organization of Stroke Care: Education, Stroke Units and RehabilitationCerebrovascular Diseases, 2000
- Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after strokeBMJ, 1997
- Effect of correcting outcome data for case mix: an example from stroke medicineBMJ, 1996
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJournal of Clinical Epidemiology, 1992
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987