Services for helping acute stroke patients avoid hospital admission.
Langhorne P., Dennis MS., Kalra L., Shepperd S., Wade DT., Wolfe CD.
BACKGROUND: Stroke patients are usually admitted to hospital for their acute care and rehabilitation. Services to help acute stroke patients avoid admission to hospital ("hospital-at-home") have now been developed. OBJECTIVES: The objective of this review was to establish the costs and effects of such services compared with conventional services. SEARCH STRATEGY: The Stroke Group Specialist Register of Controlled Trials was searched and supplemented by discussion with colleagues and trialists. This was last updated in March 1999. SELECTION CRITERIA: Controlled clinical trials recruiting stroke patients who have not been admitted to hospital and compare; a) services which provided support with an aim of helping prevent admission to hospital with b) conventional services (which could include hospital admission). DATA COLLECTION AND ANALYSIS: Two independent reviewers determined the eligibility and methodological quality of trials. Trialists were then contacted to obtain standardised descriptive and outcome data. MAIN RESULTS: Four trials are included in the review of which three currently have outcome data available (921 patients; 857 from one controlled trial, 64 from two randomised trials). There were no statistically significant differences between the patient and carer outcomes of the intervention and control groups either within individual trials or in pooled analyses. There was a trend toward greater hospital bed use and increased costs in the intervention groups. REVIEWER'S CONCLUSIONS: There is currently no evidence from clinical trials to support a radical shift in the care of acute stroke patients from hospital-based care.