Acute Stroke Management and Patient Outcome: The Value of Neurovascular Care Units (NCU)

Abstract

Medical records of 455 acute stroke patients admitted to six community hospitals between October and April, 1969 through 1970 and 1971 through 1972, were surveyed. Data were obtained for: demography, diagnosis and management, complications, patient status and outcome variables (discharge status, disposition, length of stay, mortality and survival time), for one year before and after establishment of acute neurovascular care units (NCUs) in three of the hospitals. Patient status on admission based on a self-care scale was the most accurate measure used in predicting outcome (except when secondary complications occurred). There was a significant decline in mortality for nonhemorrhagic strokes for all patients, due to reduction in complication-related deaths among younger and less impaired persons. Forty-one percent of complication-related deaths for both surveys occurred during the first nine hospital days. Complications significantly lengthened hospitalization, increased the risk of late complication-related deaths, and decreased home discharges. Complication-related deaths were reduced in the second survey. Hospitals with NCUs showed a 50% reduction in secondary complications; hospitals without NCUs showed no reduction. Frequency of complications is an excellent measure of the quality of care. The acute NCU appears to be a practical method for achieving such quality.