Abstract
We have been developing a new stroke management system based on an acute stroke unit with referral to a rehabilitation unit at another hospital (inter-hospital referral model) in contrast to the conventional system utilizing a combined acute and rehabilitation stroke unit at a single hospital (intra-hospital referrral model). The stroke management system in three acute stroke hospitals in Kumamoto was evaluated to clarify the fea-tures of this new system.
In total, 806 patients (459 men, 347 women ; age, 71.0±12.2 years old) with acute ischemic stroke admitted between May 1999 and April 2000 were prospectively enrolled into the study. All clinical data were sys-tematically documented including the final diagnosis of the stroke subtype (atherothrombotic, cardioembolic, lacunar, others or TIA), NIHSS, admission time after onset, length of hospital stay, condition at discharge and modied Rankin Scale (mRS). The most frequent stroke subtype was cardioembolic (29.4%). The average NIHSS was 8.2 (median, 5). Two-fifths of the patients were admitted within 3 hours of stroke onset. The length of hospital stay was 17.3±17.4 (median, 14) days. About 60% of the patients could walk at discharge. Two-fifths of all patients were discharged to their home, and 76.6% of them were discharged within 14 days. Another two-fifths of the patients were transferred to rehabilitation hospitals, and 62.1% of them were dis-charged within 21 days. Patients with mRS≤2 and≥4 represented 49.9% and 39.0% of all patients, respec-tively. Acute hospitals aim to provide intensive stroke care within 14 days. On the other hand, rehabilitatoin hospitals commence their program from the early stage of stroke. A community-oriented hospital-team cooperates to provide the stroke service in Kumamoto.
