Impact of a Stroke Unit on Length of Hospital Stay and In-Hospital Case Fatality

Background and Purpose—Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. Methods—A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Results—Average length of stay for patients on a stroke unit (n2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n1567). The proportion of patients with length of stay 7 days on general neurology/medical wards was 53.8 % vs 44.4 % on the stroke unit (difference 9.4%; P0.0001). The adjusted odds of a length of stay 7 days was reduced by 30 % (P0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5 % with stroke unit care