Organisation of Stroke Services: The Role of Stroke Units

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Abstract
Stroke units are gaining increasing popularity as a strategy for providing stroke care. Despite this, there continues to be considerable debate about the benefits and cost-effectiveness of such units. This paper discusses the organisation of different types of stroke units and reviews existing literature on their effectiveness in stroke management. Several studies suggest that stroke units are associated with reduced mortality, lesser institutionalisation, better functional outcome and shorter lengths of hospital stay. There is also emphasis on early admission to stroke units and early commencement of rehabilitation. Stroke intensive care units appear to contribute significantly to research on the mechanisms, diagnosis and acute management of stroke but may have a limited service role at present. This is likely to change with the development of acute medical intervention for ischaemic stroke. None of the studies on stroke rehabilitation units have resulted in a change in clinical practice because of variations in patient selection criteria, number of eligible patients who were finally included in different studies, multiplicity of assessment and outcome measures, differences in the timing, intensity and nature of therapy intervention and publication bias in favour of ''positive'' studies. Notwithstanding these limitations, there is compelling support for the establishment of stroke units to provide well-organised, patient-centred, integrated multidisciplinary care for stroke patients.

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