Jornal Internacional de Medicina Física e Reabilitação
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Impact of Acute Stroke Unit on Patient Outcomes in Saudi Arabia

Ali M Al Khathaami, Shahla Aldhokair, Maisoun Tarawneh, Ismail Khatri and Nasser Alotaibi

Background: Evidence from developed countries indicates that acute stroke units (ASUs) improve stroke outcomes. Data from developing countries on efficacy of ASUs are limited.

Aims: To determine whether establishing an ASU impacts stroke outcomes in the Saudi health care system.

Methods: This improvement project was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia from January 2012 to December 2013. An ASU was established to provide improved care for stroke patients. We compared death, unfavourable outcomes, independence at discharge, and NIHSS at discharge between patients treated by traditional practice versus those treated in an ASU using multiple regression analysis.

Results: Of 861 patients admitted with initial diagnoses of acute stroke, 525 were treated in an ASU. Patients admitted to the ASU were younger and had less medical comorbidity compared to those treated in traditional practices. After adjustment for age, sex, comorbidities, stroke severity, and stroke classification, ASU admission was associated with milder neurological deficit at discharge as measured by National Institutes of Health Stroke Scale (NIHSS). Furthermore, non-adherence to best practices was lower in patients treated in an ASU compared to general floors. Patients admitted to an ASU had shorter lengths of stay. There were no significant differences between the two groups in rate of death, unfavourable outcomes, or independence at discharge.

Conclusion: Establishment of an ASU in the Saudi health care system improved adherence to best practices, reduced LOS, and was associated with lower stroke severity at discharge.