Stroke unit (SU) with both stroke patient’s ward (or beds) and stroke team could significantly improve the outcome by decreasing mortality and increasing patients back to home with independent life in former clinical studies. In Japan, an additional payment to stroke care unit (SCU) which has the same definition as SU was introduced in public health insurance system from May, 2006. In our hospital, SCU with 6 beds and specific stroke team were organized in 2 acute patients wards composed with total 41 beds and registered from Jun, 2006. SCU was integrated with a special ward such as intensive care unit (ICU) with 14 beds for managing stroke patients with conscious disturbance or respiratory distress, IV thrombolytic therapy, and perioperative management of acute surgical or endovascular treatments. Main function of SCU was set up for acute physical rehabilitation, prevention of complications such as pneumonia, and pharmacotherapy for secondary prevention. From May, 2006 to Nov, 2008, 1,166 patients were managed in SCU. NIHSS of patients at admission was 6.3±7.0 in all stroke patients, 5.4±6.4 in patients with cerebral infarction, and 9.8±7.6 in patients with cerebral hemorrhage. Admitted period in SCU was 8.1±3.5 days in all patients, 8.1±3.6 days in patients with cerebral infarction, 8.3±3.2 days in patients with cerebral hemorrhage. Total admitted periods in hospital was 61.1±68.6 days in the first half of the investigation period (to July, 2007) and 52.5±51.8 days in the second half of the investigation period (from Aug, 2007). The outcome (mRS) at discharge was 56% in mRS 0–2, 40% in mRS 3–5, 4% in mRS 6 (death). In our stroke center, patients with mild to moderate severity were managed in SCU. After the introduction of SCU, shortening of total admitted periods in hospital and improving tendency of the outcome was observed. Stroke center equipped with SCU should be promptly organized nationwide corresponding to stroke emergency.
