Abstract
Utilization of stroke unit and acute thrombolytic therapy within 3 hours of onset introduced the new era of acute stroke therapy. Acute ischemic stroke is no longer “Cinderella disease, ” but a “brain attack” because its neurological deficit can be reversed or diminished by a dedicated management. An acute stroke center should be organized to provide the best stroke therapy at any time. Rehabilitation in the recovery stage could be done in the specialized rehabilitation hospitals within Kumamoto due to inter-hospital cooperation. Our acute stroke team can concentrate on the treatment of stroke in the acute stage (within 2-3 week from the onset). We have been developing this stroke management system based on an acute stroke unit with referral to a rehabilitation unit in other hospital (regional inter-hospital referral model) in contrast to the conventional system with a combined acute and rehabilitation stroke unit in a single hospital (intra-hospital referral model). Eight-hundred and six patients (459 male, 347 female, 71.0±12.2 years old) with acute ischemic stroke were admitted to three hospitals between May 1999 and April 2000. The average NIHSS was 8.2 (median 5). 41.3% of the patients admitted within 3 hours of stroke onset. The length of hospital stay was 17.3±17.4 (median 14) days. Two-fifth of all patients discharged to their home, and 76.6% of them discharged within 14 days. Another 2/5 patients were transferred to rehabilitation hospitals, and 62.1% of them discharged within 21 days. The reduction of length of hospital stay was achieved by the use of clinical pathway and the inter-hospital cooperation.
