Acute stroke unit care and early neurological deterioration in ischemic stroke

J Neurol. 2008 Jul;255(7):1012-7. doi: 10.1007/s00415-008-0820-z. Epub 2008 Jun 2.


Objective: To evaluate the impact that monitored acute stroke unit care may have on the risk of early neurological deterioration (END), and 90-day mortality and mortality-disability.

Methods: Non-randomized prospective study with consecutive patients with acute ischemic stroke (AIS) admitted to a conventional care stroke unit (CCSU), from May 2003 to April 2005, or to a monitored acute stroke unit (ASU) from May 2005 to April 2006. END was defined as an increase in the NIHSS score >or= 4 points in the first 72 hours after admission.

Results: END was detected in 19.6% of patients (11.2% of patients admitted to the ASU and 23.8% to the CCSU; p<0.0001). Patients admitted to the ASU received more treatment with intravenous rtPa (13.5% versus 4.2%; p<0.0001), had a shorter length of stay (9.1 [11.0] d versus 13.1 [10.4] d; p<0.0001), lower 90-day mortality (10.2% versus 17.3%; p=0.02), and lower mortality-disability at 90-days (28.4% versus 40.2%; p=0.004) than those admitted to the CCSU. Multivariable analysis showed that ASU admission was a protector for END (OR: 0.37; 95% CI: 0.23-0.62). On admission, higher NIHSS (OR: 1.06; 95% CI: 1.03-1.10), higher glycaemia (OR: 1.003; 95% CI: 1.001-1.006), and higher systolic pressure (OR: 1.01; 95% CI: 1.002-1.017) were independent predictors of END.

Conclusions: END prevention by ASU care might be a key factor contributing to better outcome and decrease of length of stay in patients admitted to monitored stroke units.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Confidence Intervals
  • Disability Evaluation
  • Disabled Persons*
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nervous System Diseases* / diagnosis
  • Nervous System Diseases* / etiology
  • Nervous System Diseases* / mortality
  • Odds Ratio
  • Prospective Studies
  • Regression Analysis
  • Retrospective Studies
  • Severity of Illness Index
  • Stroke / complications*