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Stroke Unit Care Benefits Patients With Intracerebral Hemorrhage Systematic Review and Meta-analysis

Journal article
Authors P. Langhorne
P. Fearon
O. M. Ronning
M. Kaste
H. Palomaki
K. Vemmos
L. Kalra
B. Indredavik
Christian Blomstrand
H. Rodgers
M. S. Dennis
R. A. Salman
Published in Stroke
Volume 44
Issue 11
Pages 3044-3049
ISSN 0039-2499
Publication year 2013
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Pages 3044-3049
Language en
Links dx.doi.org/10.1161/strokeaha.113.00...
Keywords hemorrhagic, meta-analysis, outcome, stroke, stroke units, RANDOMIZED CONTROLLED-TRIAL, ACUTE ISCHEMIC-STROKE, PROFESSIONALS, ASSOCIATION, GUIDELINES, MANAGEMENT
Subject categories Neurology

Abstract

Background and Purpose Patients with any type of stroke managed in organized inpatient (stroke unit) care are more likely to survive, return home, and regain independence. However, it is uncertain whether these benefits apply equally to patients with intracerebral hemorrhage and ischemic stroke. Methods We conducted a secondary analysis of a systematic review of controlled clinical trials comparing stroke unit care with general ward care, including only trials published after 1990 that could separately report outcomes for patients with intracerebral hemorrhage and ischemic stroke. We performed random-effects meta-analyses and tested for subgroup interactions by stroke type. Results We identified 13 trials (3570 patients) of modern stroke unit care that recruited patients with intracerebral hemorrhage and ischemic stroke, of which 8 trials provided data on 2657 patients. Stroke unit care reduced death or dependency (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.471-0.92; P=0.0009; I-2=60%) with no difference in benefits for patients with intracerebral hemorrhage (RR, 0.79; 95% CI, 0.61-1.00) than patients with ischemic stroke (RR, 0.82; 95% CI, 0.70-0.97; P-interaction=0.77). Stroke unit care reduced death (RR, 0.79; 95% CI, 0.64-0.97; P=0.02; I-2=49%) to a greater extent for patients with intracerebral hemorrhage (RR, 0.73; 95% CI, 0.54-0.97) than patients with ischemic stroke (RR, 0.82; 95%, CI 0.61-1.09), but this difference was not statistically significant (P-interaction=0.58). Conclusions Patients with intracerebral hemorrhage seem to benefit at least as much as patients with ischemic stroke from organized inpatient (stroke unit) care.

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