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Stroke unit care revisited – who benefits the most? A cohort study of 105 043 patients in Riks-Stroke, the Swedish Stroke Register
  1. Andreas Terent (andreas.terent{at}medsci.uu.se)
  1. Department of Medical Sciences Uppsala University Hospital Uppsala, Sweden
    1. Kjell Asplund (kjell.asplund{at}branneriet.se)
    1. Department of Public Health and Clinical Medicine Umeå University Hospital Umeå, Sweden
      1. Bahman Farahmand (bahman.farahmand{at}astrazeneca.com)
      1. Insitutute of Environmental Medicine Karlinska Institute Stockholm, Sweden
        1. Karin Henriksson (karin.henriksson{at}astrazeneca.com)
        1. Department of Laboratory Medicine Lunds University Hospital Lund, Sweden
          1. Bo Norrving (bo.norrving{at}skane.se)
          1. Department of Neurology Lunds University Hospital Lund, Sweden
            1. Birgitta Stegmayr (birgitta.stegmayr{at}socialstyrelsen.se)
            1. Department of Public Health and Clinical Medicine Umeå University Hospital Umeå, Sweden
              1. Per-Olov Wester (per-olov.wester{at}bredband.net)
              1. Department of Public Health and Clinical Medicine Umeå University Hospital Umeå, Sweden
                1. Kerstin Hulter-Åsberg (kerstin.hulter.asberg{at}lul.se)
                1. Drug and Therapeutic Committee County Council of Uppsala, Sweden
                  1. Signild Åsberg (signild.asberg{at}akademiska.se)
                  1. Department of Medical Sciences Uppsala University Hospital Uppsala, Sweden

                    Abstract

                    Background: Treatment at stroke units is superior to treatment at other types of wards. The objective of the present study is to determine the effect size of stroke unit care in subgroups of stroke patients. This information might be useful in a formal priority setting.

                    Methods: All acute strokes reported to the Swedish Stroke Register the year 2001 through 2005, were followed up until January 31, 2007. The subgroups were age (18-64, 65-74, 75-84, 85 years and above), sex (male, female), stroke subtype (intracerebral haemorrhage, cerebral infarction and unspecified stroke), and level of consciousness (conscious, reduced, unconscious). Cox proportional hazards and logistic regression analyses was used to estimate the risk for death, institutional living or dependency.

                    Results: 105 043 patients wee registered at 86 hospitals in a population of 9 million inhabitants.79 689 patients (76%) were treated in stroke units and 25 354 patients (24%) in other types of wards. Stroke unit care was associated with better long-term survival in all subgroups. The best effect of stroke unit care was seen among the following subgroups: age 18-64 years (hazard ratio (HR) for death 0.53; 0.49 to 0.58), intracerebral haemorrhage (HR 0.61; 0.58 to 0.65) and unconsciousness (HR 0.70; 0.66 to 0.75). Stroke unit care was also associated with reduced risk for death or institutional living after 3 months.

                    Conclusions: Stroke unit care was associated with better outcome in all subgroups, but younger patients, patients with intracerebral haemorrhage and patients who were unconscious had the best effect.

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