Abstract
Background and aim Randomised trials indicate that stroke unit care reduces morbidity and mortality after stroke. Similar results have been seen in observational studies but many have not corrected for selection bias or independent predictors of outcome. We evaluated the effect of stroke unit compared with general ward care on outcomes after stroke in Scotland, adjusting for case mix by incorporating the six simple variables (SSV) model, also taking into account selection bias and stroke subtype.
Methods We used routine data from National Scottish datasets for acute stroke patients admitted between 2005 and 2011. Patients who died within 3 days of admission were excluded from analysis. The main outcome measures were survival and discharge home. Multivariable logistic regression was used to estimate the OR for survival, and adjustment was made for the effect of the SSV model and for early mortality. Cox proportional hazards model was used to estimate the hazard of death within 365 days.
Results There were 41 692 index stroke events; 79% were admitted to a stroke unit at some point during their hospital stay and 21% were cared for in a general ward. Using the SSV model, we obtained a receiver operated curve of 0.82 (SE 0.002) for mortality at 6 months. The adjusted OR for survival at 7 days was 3.11 (95% CI 2.71 to 3.56) and at 1 year 1.43 (95% CI 1.34 to 1.54) while the adjusted OR for being discharged home was 1.19 (95% CI 1.11 to 1.28) for stroke unit care.
Conclusions In routine practice, stroke unit admission is associated with a greater likelihood of discharge home and with lower mortality up to 1 year, after correcting for known independent predictors of outcome, and excluding early non-modifiable mortality.
Methods We used routine data from National Scottish datasets for acute stroke patients admitted between 2005 and 2011. Patients who died within 3 days of admission were excluded from analysis. The main outcome measures were survival and discharge home. Multivariable logistic regression was used to estimate the OR for survival, and adjustment was made for the effect of the SSV model and for early mortality. Cox proportional hazards model was used to estimate the hazard of death within 365 days.
Results There were 41 692 index stroke events; 79% were admitted to a stroke unit at some point during their hospital stay and 21% were cared for in a general ward. Using the SSV model, we obtained a receiver operated curve of 0.82 (SE 0.002) for mortality at 6 months. The adjusted OR for survival at 7 days was 3.11 (95% CI 2.71 to 3.56) and at 1 year 1.43 (95% CI 1.34 to 1.54) while the adjusted OR for being discharged home was 1.19 (95% CI 1.11 to 1.28) for stroke unit care.
Conclusions In routine practice, stroke unit admission is associated with a greater likelihood of discharge home and with lower mortality up to 1 year, after correcting for known independent predictors of outcome, and excluding early non-modifiable mortality.
Original language | English |
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Pages (from-to) | 314-318 |
Number of pages | 5 |
Journal | Journal of Neurology, Neurosurgery & Psychiatry |
Volume | 86 |
Issue number | 3 |
Early online date | 25 Jun 2014 |
DOIs | |
Publication status | Published - Mar 2015 |
Bibliographical note
Funding: This study was funded by Chest, Heart and Stroke Scotland (Grant no R11/A134). The SSCA is funded by NHS Scotland via ISD. Neither funder had any role in the analysis.Acknowledgments: We are grateful to David Murphy of the SSCA for providing data and to Lynsey Waugh of ISD Scotland for linking the SSCA data with General Register Office data. We also acknowledge the help of all who enter data into SSCA.
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Mary MacLeod
- School of Medicine, Medical Sciences & Nutrition, Cardiometabolic Disease
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cardiovascular and Diabetes Centre
- School of Medicine, Medical Sciences & Nutrition, Applied Medicine - Senior Clinical Lecturer
- School of Medicine, Medical Sciences & Nutrition, Institute of Medical Sciences
Person: Clinical Academic
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Melanie Turner
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Centre for Health Data Science
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Research Fellow
- School of Medicine, Medical Sciences & Nutrition, Grampian Data Safe Haven (DaSH)
- Institute of Applied Health Sciences
Person: Academic Related - Research