The impact of stroke unit care on outcome in a Scottish stroke population, taking into account case mix and selection bias

Turner, M., Barber, M., Dodds, H., Dennis, M., Langhorne, P. and Macleod, M. J. (2015) The impact of stroke unit care on outcome in a Scottish stroke population, taking into account case mix and selection bias. Journal of Neurology, Neurosurgery and Psychiatry, 86(3), pp. 314-318. (doi:10.1136/jnnp-2013-307478) (PMID:24966391) (PMCID:PMC4345522)

[img]
Preview
Text
104268.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial.

443kB

Abstract

Background and aim: Randomised trials indicate that stroke unit care reduces morbidity and mortality after stroke. Similar results have been seen in observational studies but many have not corrected for selection bias or independent predictors of outcome. We evaluated the effect of stroke unit compared with general ward care on outcomes after stroke in Scotland, adjusting for case mix by incorporating the six simple variables (SSV) model, also taking into account selection bias and stroke subtype.<p></p> Methods: We used routine data from National Scottish datasets for acute stroke patients admitted between 2005 and 2011. Patients who died within 3 days of admission were excluded from analysis. The main outcome measures were survival and discharge home. Multivariable logistic regression was used to estimate the OR for survival, and adjustment was made for the effect of the SSV model and for early mortality. Cox proportional hazards model was used to estimate the hazard of death within 365 days.<p></p> Results: There were 41 692 index stroke events; 79% were admitted to a stroke unit at some point during their hospital stay and 21% were cared for in a general ward. Using the SSV model, we obtained a receiver operated curve of 0.82 (SE 0.002) for mortality at 6 months. The adjusted OR for survival at 7 days was 3.11 (95% CI 2.71 to 3.56) and at 1 year 1.43 (95% CI 1.34 to 1.54) while the adjusted OR for being discharged home was 1.19 (95% CI 1.11 to 1.28) for stroke unit care.<p></p> Conclusions: In routine practice, stroke unit admission is associated with a greater likelihood of discharge home and with lower mortality up to 1 year, after correcting for known independent predictors of outcome, and excluding early non-modifiable mortality.<p></p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Langhorne, Professor Peter
Authors: Turner, M., Barber, M., Dodds, H., Dennis, M., Langhorne, P., and Macleod, M. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Journal of Neurology, Neurosurgery and Psychiatry
Publisher:BMJ Publishing Group
ISSN:0022-3050
ISSN (Online):1468-330X
Copyright Holders:Copyright © 2014 BMJ Publishing Group
First Published:First published in Journal of Neurology, Neurosurgery and Psychiatry 86(3):314-318
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record