Stroke intensive care units: objectives and results.

Objectives and ResultsASSESSMENT of the value of Stroke Intensive Care Units has been mainly related to reports dealing with mortality from stroke in patients cared for in such units -an easily definable end point.The reports in the literature vary from that of Kennedy et al., which concludes that "special intensive care units devoted only to the acute phase care of the stroke patient, even with specially trained nurses, are not productive in terms of a reduction in stroke deaths," to that of Taylor, 2 who reported mortality was lowered from 49% to 13%.Drake et al. 3 reported that "hospitals with neurovascular care units showed a 50% reduction in secondary complications; hospitals without neurovascular care units showed no reduction."Associated with this decreased complication rate was a decrease in mortality for non-hemorrhagic strokes.Experience in a combined (cardiac and cerebrovascular disease) unit was described by Cooper et al. 4 but is difficult to interpret.The mortality rate for patients with subarachnoid hemorrhage in the unit was 40%; before the unit was formed, 6/6 patients died.The authors mention that the accuracy of diagnosis of subarachnoid hemorrhage and intracerebral hemorrhage was uncertain.When patients with each were grouped, there was no difference in the mortality in the control population and in the intensive care unit population.The authors reported several non-objective advantages of the unit; 1) efficiency of patient care was improved, 2) awakening of the interest of the medical, nursing and paramedical profession to the problem of acute stroke was noted and 3) the unit provided a focal area for education concerning stroke.Pitner and Cornelius 6 wrote, "the conclusion seems inescapable that stroke ICUs are not productive in reducing mortality in the acute stroke patient, at least in a general hospital setting."In this report 81 patients admitted to a 4-bed stroke intensive care unit were compared with 81 control cases."No significant differences in overall mortality (33% versus 27%) or in mortality by diagnostic category were found."Norris and Hachinski 8 studied 199 patients with stroke admitted to an intensive stroke care unit during the first year.The results were not compared to Supported in part by NIH Grant P 17 NS11098-03, Stroke Acute Care Research Unit.