General care is essential and must already start outside the hospital, and comprises respiratory and cardiac care, fluid and metabolic management, especially blood glucose control, avoiding the administration of glucose solutions, blood pressure control, early treatment of hyperthermia and prevention and treatment of neurologic and systemic complications.
Patients are then transferred to a dedicated stroke unit where management is continued by a multidisciplinary team. A rapid response and care in a designated unit is crucial to improvements in stroke care. Such units will have protocols and guidelines to streamline care and reduce inefficiency
Nowadays, the concept of stroke units has changed to a non-intensive-care setting. The benefit of these units has been amply demonstrated in terms of reduction in mortality and in long institutionalization, as well as better functional outcome compared with general wards, and the efficacy of a neurology ward compared to a general medicine department has also been shown.
Stroke units reduce mortality and dependence.
A study compared differences in management and complications of patients with acute stroke who were admitted to a stroke unit or to a general ward as part of a previously reported randomised trial. 304 patients had been randomly assigned to stroke units (n=152) or to general wards supported by a specialist stroke team (n=152).
Complications were less frequent in patients in the stroke unit than those in general wards (0.6 [0.2-0.7]), with fewer patients having progression of stroke, chest infection, or dehydration. Measures to prevent aspiration, early feeding, stroke unit management, and frequency of complications independently affected outcome.
