Abstract Details

Title Stroke Unit Versus Medical Wards: What Makes the Difference? The Importance of Etiopatogenetic Diagnosis According to TOAST Criteria

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 231

Objective

Background BACKGROUND: Previous studies clarify several ways in which Stroke unit care reduces case fatality and disability in ischemic stroke patients, but they didn't evaluate if a valid etiologic subtype classification of ischemic stroke according to TOAST criteria provides a much better understanding of these benefits.

Design/Methods DESIGN/METHODS: This study is a part of a 2-year prospective community-based registry of all cerebrovascular events in a health district of Udine, north-east of Italy, between April 1st 2007 and March 31st 2009. Multiple overlapping sources for case finding were used, combing hot- and cold-pursuit.

Results RESULTS: We identified 425 first ever ischemic stroke, 69% were admitted to a Stroke Unit care while 31% in Medical Wards. According to TOAST criteria in Medical wards 76,52% of patients were classified of undetermined etiology; in Stroke Unit this percentage was 35,16%. At 6 months survival rates for Stroke unit patients were significantly higher than in Medical Ward patients, respectively 81,51% (95% CI 76,56%-85,51%) and 59,23%(95% CI 50,28%-67,11%) (log-rank test p<0.0001). The percentage of high disability rate (Ranking 3-5) among surviving patients was 35,65% for Stroke Unit and 58,73% for Medical Wards. Multivariate analysis showed that patients with a stroke with a definite etiology were less likely to be dead at 6 month than those undetermined (OR=0,27; 95% CI 0,14-0,51; p < 0,0001); patients benefited from treatment in Stroke Unit as compared with Medical Wards in terms of both high disability (OR=0,48; 95% CI 0,23-0,96; p= 0,039) and death or high disability outcome (OR=0,51; 95% CI 0,26-0,96; p= 0,039).

Conclusions CONCLUSIONS: A valid etiologic classification of stroke according to TOAST criteria improves outcome in Stroke Unit patients.

Authors/Disclosures
Gian Luigi L. Gigli, MD (Universita di Udine - Clinica Neurologica) PRESENTER	No disclosure on file
Lucio D'Anna	No disclosure on file
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Dileep R. Yavagal, MD, FAAN (University of Miami Miller School of Medicine)	Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vascular Dynamics. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. The institution of Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus/Johnson & Johnson. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Poseydon. Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Athersys. Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gravity Medical Technology. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Poseydon. Dr. Yavagal has stock in Poseydon. Dr. Yavagal has stock in Galaxy Therapeutics. Dr. Yavagal has stock in Stentrode. Dr. Yavagal has stock in Gravity Medical. Dr. Yavagal has stock in Gravity Medical Technology. Dr. Yavagal has stock in Athersys. Dr. Yavagal has stock in Rapid Medical . Dr. Yavagal has received intellectual property interests from a discovery or technology relating to health care. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Expert with Royal Carribean Cruise Line. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Consultant with Carnival Cruise Line.
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