[Hospital care of stroke patients: importance of expert neurological care]

Abstract

Background: PRACTIC is an observational, epidemiological, multi-center, prospective registry of patients admitted to the emergency room with acute stroke. We aim to study the impact of admission to a specialized neurology ward, either a Stroke Unit or by a Stroke Team, on several outcomes.

Methods: Ten consecutive acute stroke patients admitted to the emergency room of 88 different hospitals of all levels of care in all regions of Spain were included. Only patients who gave informed consent were studied. Oxfordshire Community Stroke Project, TOAST subtypes and modified Rankin Scale (mRS) were determined. At six months, stroke or any other vascular recurrence was recorded.

Results: from a total of 864 patients, 729 (84.4%) were admitted; 555 (76.1%) in a specialized neurology ward (SNW) and 174 (23.9%) in a general medicine ward. Patients admitted in a SNW were younger and had higher rates of transient ischemic attack (TIA) or intracerebral hemorrhage (ICH). Regarding outcomes, patients admitted to an SNW had lower rate of hospital complications (35.5 vs. 50.6%; P<.001) higher rates of discharge mRS ≤ 2 (65.4 vs. 52.3%; P=.002) and lower mortality rates (2.9 vs. 8.0%; p=.003). Adjusted logistic regression models showed that admission to a SNW reduces hospital complications (OR 0.53, 95% CI 0.37-0.77; p=.001), hospital mortality (0.34, 0.15-0.77; p=.01) and a better prognosis at discharge, mRS ≤ 2 (1.51, 1.00-2.29; p=.05). A better hospital outcome was observed for all ischemic stroke subtypes in an SNW, particularly for those with Partial Anterior Circulation Infarct. At six months, patients admitted to an SNW had higher percentages on the mRS ≤ 2 (1.9, 1.08-3.27; p=.025), and lower rates of recurrent strokes (HR 0.49, 0.26-0.92; p=.025) or any vascular event (HR 0.50, 0.30-0.84; p=.009).

Conclusions: in stroke patients, specialized neurological care, either in a Stroke Unit or by a Stroke Team, decreases mortality and hospital complications, thus lowering disability. A better outcome is sustained at 6 months when patients were admitted to an SNW. They have better functional status and lower rate of stroke or other vascular event recurrence. These data reinforce the need for specialized neurological hospital care for stroke patients.