Objective: We set out to determine the effect of establishing a co-ordinated network of 22 metropolitan stroke units in New South Wales.
Methods: We identified patients admitted to a stroke unit hospital from 2000-2006 with an acute principal or stay diagnosis of ischaemic stroke (I63.x). Fact of death and other outcomes were available through data linkage. Outcomes were compared before and after stroke service enhancement.
Results: Of the 17,431 admissions to the 22 stroke unit hospitals, 43.6% were treated before stroke unit inception. The median patient age was 76 years (IQR=67-83 years) and was similar before and after stroke unit inception (p>0.05). Overall, 30-, 90- and 365-day crude mortality rates were 13.1% (n=2282), 18.3% (n=3195) and 26.1% (n=4554), respectively.
There was significant heterogeneity of stroke unit implementation according to hospital type. Mortality rates were similar before and after stroke unit implementation amongst admissions to principal referral hospitals. However, for admissions treated in non-principal referral hospitals, 30-day, 90-day and 365-day survival was significantly improved (AOR=0.65, 95% CI 0.59-0.73; AOR=0.67, 95% CI 0.60-0.75 and AOR=0.72, 95% CI 0.63-0.83, respectively), when controlling for patient characteristics, comorbidities and clustering effects. Mortality rates in non-principal referral hospitals fell to levels observed in principal referral hospitals (eg: 90-day mortality 17.8% versus 17.6%, respectively).
Conclusion: Significant and lasting benefits were realised with a co-ordinated roll-out of enhanced stroke services across a network of 22 hospitals. Improvements were seen in non-principal referral hospitals where organised stroke care had been modest or absent.