Stroke unit care in clinical practice: An observational study in the Florence center of the European Registers of Stroke (EROS) Project

Background: Randomized trials and meta-analyses indicate positive effects of stroke unit (SU) care on survival and dependency of patients with stroke. However, data on the advantages of SU in 'real-world' settings are limited. We prospectively assessed, in a large University Hospital, the effect of SU versus other conventional wards (OCW) care on all-cause mortality, death or dependency, death or institutionalization. Methods: In a prospective observational study in the European Registers of Stroke Project, patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, 3-month and 1-year survival, and functional outcome. Results: Overall, 355 patients (54.1% men, mean age 73.4±14.5years) were registered, 140 (39.4%) admitted to the SU, and 215 (60.6%) to OCW. OCW patients were older, whilst SU patients had more severe strokes according to NIHSS (P for trend=0.025). SU patients were significantly more often treated by specialists in stroke medicine, stroke nurses, physiotherapists and speech therapists (all P<0.001), psychologists (P=0.025), dietitians (P<0.001), and social workers (P=0.003). MRI, carotid, and transcranial Doppler were significantly more often performed in SU patients (all P<0.001). Intravenous fluids (P=0.003) and intravenous anticoagulation (P<0.001) were more often prescribed in SU. Controlling for case-mix, SU significantly reduced 1-year mortality (P=0.020), death or dependency at 3months (P=0.006) and 1year (P=0.043), and death or institutionalization at 3months (P=0.001) and 1year (P=0.009). Conclusions: We confirmed the benefits of SU care in a clinical setting. Further analyses should define the contribution of individual components of care to stroke outcome. © 2010 The Author(s). European Journal of Neurology © 2010 EFNS.