Post-stroke patients : stroke unit outcomes compared with general medical wards

Abstract

Stroke, also referred to as cerebrovascular accident (CVA), is a condition, affecting approximately 5.5million people worldwide. It leads to the disruption of oxygen and nutrient supply to the brain, hence resulting in the death of brain cells, leading to severe brain damage if not immediately treated. As a result, persons affected by CVA can lose the function of parts of the body, which may lead to disability and even death. PICO question: In patients with cerebrovascular accident, do stroke in-patient units reduce mortality, functional dependency and institutionalisation, when compared to general medical wards? This question identifies patients following a CVA as the population, stroke units as the intervention, and general medical wards as the comparison. It also highlights the outcomes, namely: mortality, institutionalisation, and dependency. The studies chosen had to compare stroke units with general medical wards, and include the outcomes mentioned. The types of studies included were randomised control studies (RCTs), systematic reviews and metaanalyses, and had to be available in full text. The final outcome of the search led to one systematic review and meta-analyses, two systematic reviews, and four RCTs. Assessing the quality of the selected studies was carried out using the appropriate CASP tool, in correspondence with the study type. The CASP tool was also used to critically discuss and obtain optimal results. The findings of this research concluded that stroke units showed no significant difference in mortality, while having a significant difference on institutionalisation and dependency. Malta has a high rate of admissions of patients following a stroke with the second highest rate of mortality in Europe. In response to this, this review recommends that a stroke unit is established locally, or that the adoption of the stroke unit’s approach is applied to stroke patients admitted to general medical or neuromedical wards.