Dataset Information

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

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.

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.

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.

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.

SUBMITTER: Turner M

PROVIDER: S-EPMC4345522 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Publications

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

Turner Melanie M Barber Mark M Dodds Hazel H Dennis Martin M Langhorne Peter P Macleod Mary Joan MJ

Journal of neurology, neurosurgery, and psychiatry 20140625 3

<h4>Background and aim</h4>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 ...[more]

PMID: 24966391

Similar Datasets

Project description:Clinical trials are the hallmark of evidence-based medicine, but recruitment is often challenging, especially in stroke trials investigating patients not being able to give informed consent. In some nations, ethics committees will not approve of inclusion in a clinical study via consent of a legal representative. The ethical dilemma of including or excluding those patients has not been properly addressed, as there is little data on the effect of stroke characteristics on the ability to give informed consent.To examine differences between patients able and unable to consent at inclusion to an acute stroke trial, we conducted a post-hoc analysis of monitoring records from a multicentric interventional trial. These records listed patients who gave informed consent by themselves and those who needed a legal representative to do so. This exemplary STRAWINSKI trial aimed at improving stroke outcome by biomarker-guided antibiotic treatment of stroke associated pneumonia and included patients within 40 h after stroke onset, suffering from MCA infarctions with an NIHSS score?>?9 at admission. Standard descriptive and associative statistics were calculated to compare baseline characteristics and outcome measures between patients who were able to consent and those who were not.We identified the person giving consent in 228 out of 229 subjects. Patients with inability to consent were older (p?<?0.01), suffered from more left-hemispheric (p?<?0.01) and more severe strokes (NIHSS, p?<?0.01), were more likely to die during hospitalisation (p?<?0.01) or have unfavourable outcome at discharge (mRS, p?<?0.01), to develop fever (p?<?0.01) and tended to be more susceptible to infections (p?=?0.06) during the acute course of the disorder.Demographics, stroke characteristics and outcomes significantly affect stroke patients in their ability to consent. Where selection criteria and primary outcome measures of a trial are significantly affected by ability to consent, excluding patients unable to consent might be unethical.URL http://www.clinicaltrials.gov . Unique identifier: NCT01264549 .

Dataset Information

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

Background and aim

Methods

Results

Conclusions

Publications

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

Similar Datasets

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