Skip to main content

Advertisement

SpringerLink
Log in

Acute stroke unit care and early neurological deterioration in ischemic stroke

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

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 ≥ 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Aho K, Harmsen P, Hatano S, MarquardsenJ, Smirnov VE, Strasser T(1980) Cerebrovascular disease in thecommunity: results of a WHO collaborativestudy. Bull World Health Org58:113–130

    PubMed  CAS  Google Scholar 

  2. Alvarez FJ, Segura T, Castellanos M,Leira R, Blanco M, Castillo J, DávalosA, Serena J (2004) Cerebral hemodynamicreserve and early neurologicdeterioration in acute ischemic stroke.J Cereb Blood Flow Metab 24:1267–1271

    PubMed  Google Scholar 

  3. Candelise L, Gattinoni M, Bersano A,Micieli G, Sterzi R, Morabito A, on thebehalf of the PROSIT Study Group(2007) Stroke-unit care for acutestroke patients: an observationalfollow-up study. Lancet 369:299–305

    Article  PubMed  Google Scholar 

  4. Castillo J, Dávalos A, Noya M (1997)Progression of ischaemic stroke andexcitotoxic aminoacids. Lancet 349:79–83

    Article  PubMed  CAS  Google Scholar 

  5. Castillo J, Leira R (2001) Predictors ofdeteriorating cerebral infarct: role ofinflammatory mechanisms. Would itsearly treatment be useful? CerebrovascDis 11(Suppl 1):40–48

    Article  Google Scholar 

  6. Cavallini A, Micieli G, Marcheselli S,Quaglini S (2003) Role of monitoringin management of acute ischemicstroke patients. Stroke 34:2599–2603

    Article  PubMed  Google Scholar 

  7. Davenport RJ, Dennis MS, Wellwood I,Warlow CP (1996) Complications afteracute stroke. Stroke 27:415–420

    PubMed  CAS  Google Scholar 

  8. DeGraba TJ, Hallenbeck JM, PettigrewKD, Dutka AJ, Kelly BJ (1999) Progressionin acute stroke: value of the initialNIH Stroke Scale score on patientstratification in future trials. Stroke30:1208–1212

    PubMed  CAS  Google Scholar 

  9. Evans A, Harraf F, Donaldson N, KalraL (2002) Randomized controlled studyof stroke unit care versus stroke teamcare in different stroke subtypes.Stroke 33:449–455

    Article  PubMed  Google Scholar 

  10. Glader EL, Stegmayr B, Johansson L,Hulter-Åsberg K, Wester PO (2001)Differences in long-term outcomesbetween patients treated in strokeunits and in general wards. A 2 yearfollow-up of stroke patients in Sweden.Stroke 32:2124–2130

    Article  PubMed  CAS  Google Scholar 

  11. Goldstein LR, Samsa GP (1997) Reliabilityof the National Institutes ofHealth Stroke Scale. Extension to nonneurologistsin the context of a clinicaltrial. Stroke 28:307–310

    PubMed  CAS  Google Scholar 

  12. Grotta JC, Welch KMA, Fagan SC, LuM, Frankel MR, Brott T, Levine SR,Lyden PD (2000) Clinical deteriorationfollowing improvement in the NINDSrt-PA Stroke Trial. Stroke 32:661–668

    Google Scholar 

  13. Gubitz G, Sandercock P (2002) Strokemanagement. Clin Evid 161–174

  14. Indredavik B, Bakke F, Slørdahl SA,Rokseth R, Håheim LL (1997) Strokeunit treatment. Long-term effects.Stroke 28:1861–1866

    PubMed  CAS  Google Scholar 

  15. Johnston KC, Li JY, Lyden PD, HansonSK, Feasby TE, Adams RJ, Faught RE Jr,Haley EC Jr (1998) Medical and neurologicalcomplications of ischemicstroke: experience from the Ranttastrial. Ranttas investigators. Stroke29:447–453

    PubMed  CAS  Google Scholar 

  16. Jorgensen HS, Nakayama H, RaaschouHO, Olsen TS (1994) Effect of bloodpressure and diabetes on stroke inprogression. Lancet 344:156–159

    Article  PubMed  CAS  Google Scholar 

  17. Kapral MK, Laupacis A, Phillips SJ,Silver FL, Hill MD, Fang J, Richards J,Tu JV (2004) Investigators of the Registryof the Canadian Stroke NetworkStroke care delivery in institutionsparticipating in the Registry of theCanadian Stroke Network. Stroke 35:1756–1762

    Article  PubMed  Google Scholar 

  18. Langhorne P, Stott DJ, Robertson L,MacDonald J, Jones L, McAlpine C,Dick F, Taylor GS, Murray G (2000)Medical complications after stroke: amulticenter study. Stroke 31:1223–1229

    PubMed  CAS  Google Scholar 

  19. Rocco A, Pasquini M, Cecconi E,Sirimarco G, Ricciardi MC, Vicenzini E,Altieri M, Di Piero V, Lenzi GL (2007)Monitoring after the acute stage ofstroke: a prospective study. Stroke38:1225–1228

    Article  PubMed  Google Scholar 

  20. Roden-Jullig A, Britton M (2000) Effectivenessof heparin treatment for progressingischemic stroke: before andafter study. J Int Med 248:287–291

    Article  CAS  Google Scholar 

  21. Roden-Jullig A, Britton M, MalmkvistK, Leijd B (2003) Aspirin in the preventionof progressing stroke: a randomisedcontrolled study. J Int Med254:584–590

    Article  CAS  Google Scholar 

  22. Seenan P, Long M, Langhorne P (2007)Stroke Units in Their Natural Habitat.Systematic Review of ObservationalStudies. Stroke 38:1886–1892

    Article  PubMed  Google Scholar 

  23. Serena J, Rodríguez-Yáñez M, CastellanosM (2006) Deterioration in AcuteIschemic Stroke as the Target forNeuroprotection. Cerebrovasc Dis21:80–88

    Article  PubMed  Google Scholar 

  24. Silva Y, Puigdemont M, Castellanos M,Serena J, Suner RM, Garcia MM,Dávalos A (2005) Semi-intensivemonitoring in acute stroke and long-termoutcome. Cerebrovasc Dis 19:23–30

    Article  PubMed  Google Scholar 

  25. Stroke Unit Trialists’ Collaboration(1997) Collaborative systematic reviewof the randomised trials of organisedinpatient (stroke unit) care afterstroke. BMJ 314:1151–1159

    Google Scholar 

  26. Sulter G, Elting JW, Langedijk M,Maurits NM, De Keyser J (2003) Admittingacute ischemic stroke patientsto a stroke care monitoring unit versusa conventional stroke unit: a randomizedpilot study. Stroke 34:101–104

    Article  PubMed  Google Scholar 

  27. Toni D, Fiorelli M, Gentile M, BastianelloS, Sacchetti ML, Argentino C,Pozzilli C, Fieschi C (1995) Progressingneurological deficit secondary to acuteischemic stroke: a study on predictability,pathogenesis and prognosis.Arch Neurol 52:670–675

    CAS  Google Scholar 

  28. Weimar C, Mieck T, Buchthal J, EhrenfeldCE, Schmid E, Diener HC. GermanStroke Study Collaboration (2005)Neurologic Worsening During theAcute Phase of Ischemic Stroke. ArchNeurol 62:393–397

    Google Scholar 

  29. Warlow C, Wardlaw J (2003) Therapeuticthrombolysis for acute ischaemicstroke. BMJ 326:233–234

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unitat d’Ictus, Servei de Neurologia, Hospital Universitari del Mar, Dept. de Medicina, Universitat Autònoma de Barcelona IMIM-Hospital del Mar, Passeig Marítim 25–29, 08003, Barcelona, Spain

    Jaume Roquer MD, PhD, Ana Rodríguez-Campello MD, Meritxell Gomis MD, Jordi Jiménez-Conde MD, Elisa Cuadrado-Godia MD, Rosa Vivanco MD, Eva Giralt MD, Maria Sepúlveda MD, Claustre Pont-Sunyer MD & Angel Ois MD

Authors
  1. Jaume Roquer MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Rodríguez-Campello MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meritxell Gomis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jordi Jiménez-Conde MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elisa Cuadrado-Godia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rosa Vivanco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eva Giralt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Sepúlveda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Claustre Pont-Sunyer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gracia Cucurella
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Angel Ois MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaume Roquer MD, PhD.

Additional information

Funding This study was funded in part by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III (Red HERACLES RD06/0009), and by FIS Number PI051737.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roquer, J., Rodríguez-Campello, A., Gomis, M. et al. Acute stroke unit care and early neurological deterioration in ischemic stroke. J Neurol 255, 1012–1017 (2008). https://doi.org/10.1007/s00415-008-0820-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-008-0820-z

Key words

Search

Navigation