Effect of in-hospital medical complications on case fatality post-acute ischemic stroke: data from the China National Stroke Registry / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset. However, few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke. In this prospective work, the China National Stroke Registry Study, we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke.</p><p><b>METHODS</b>From September 2007 to August 2008, we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China. Medical complications, case fatality and other information recorded at baseline, during hospitalisation, and at 3, 6, and 12 months after stroke onset. Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke.</p><p><b>RESULTS</b>There were 39 741 patients screened, 14 526 patients with acute ischemic stroke recruited, and 11 560 ischemic stroke patients without missing data identified during the 12-month follow-up. Of the 11 560 ischemic patients, 15.8% (1826) had in-hospital medical complications. The most common complication was pneumonia (1373; 11.9% of patients), followed by urinary tract infection and gastrointestinal bleeding. In comparison with patients without complications, stroke patients with complications had a significantly higher risk of death during their hospitalization, and at 3, 6 and 12 months post-stroke. Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period (adjusted OR = 6.946; 95%CI 5.181 to 9.314), at 3 months (adjusted OR = 3.843; 95%CI 3.221 to 4.584), 6 months (adjusted OR = 3.492; 95%CI 2.970 to 4.106), and 12 months (adjusted OR = 3.511; 95%CI 3.021 to 4.080). Having multiple complications strongly increased the death risk of patients.</p><p><b>CONCLUSION</b>Short-term and long-term outcomes of acute stroke patients are affected by in-hospital medical complications.</p>

Assessment of the early effectiveness of a stroke unit in comparison to the general ward / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Stroke unit is the most effective treatment method to benefit stroke patients. Our study is to evaluate the early effectiveness of a hospital stroke unit (SU).</p><p><b>METHODS</b>Three hundred and ninety-two patients who had suffered from acute strokes and who were admitted to our hospital between December 2001 and January 2003 were recruited for this controlled study. All patients were sent at random to either the SU or the general ward (GW) for treatment. The following indices were measured by: Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS), Oxford Handicap Scale (OHS).</p><p><b>RESULTS</b>The mean change in BI score between the day of admission and the day of discharge was 20.00 +/- 24.36 for the SU group and 10.63 +/- 23.59 for the GW group. A difference that is statistically significant (P = 0.000). The mean change in NIHSS score was -2.01 +/- 6.61 for the SU group and 0.55 +/- 7.44 for the GW group. A difference that is also statistically significant (P = 0.000). Finally, the mean change in OHS score was -0.74 +/- 1.04 for the SU group and -0.28 +/- 0.98 for the GW group, also a statistically significant difference (P = 0.000). Among SU patients, patient satisfaction was higher (P = 0.000), the rehabilitation success rate was higher (P = 0.000), and there were fewer complications (P = 0.000).</p><p><b>CONCLUSION</b>Compared to GW patients, stroke patients treated in a special SU were able to return to normal daily activities earlier, with better social abilities, and have reduced neurological defects, without increasing the overall economic burden.</p>