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Management of stroke patients with specialist stroke units hastens recovery but is not believed to influence mortality.We did a statistical overview of randomised controlled trials reported between 1962 and 1993 in which the management of stroke patients in a specialist unit was compared with that in general wards.We identified 10 trials,8 of which used a strict randomisation procedure.1586 stroke patients were included:766 were allocated to a stroke unit and 820 to general wards.The odds ratio(stroke unit vs general wards)for mortality within the first 4 months(medial follow-up 3 months)after the stroke was 0.72(95%CI 0.56-0.92),consistent with a reduction in mortality of 28%(2p<0.01).This reduction persisted (odds ratio 0.79,95%CI 0.63-0.99,2p<0.05)when calculated for mortality during the first 12 months.The findings were not significantly altered if the analysis was limited to studies that used a formal randomisation procedure.We conclude that management of stroke patients in a stroke unit is associated with a sustained reduction in mortality. |
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