Stroke: an orgnised inpatient multidisciplinary team approach reduces death and dependency

Clinical bottom line (level 1a)

Patients with an acute stroke who receive organised inpatient multidisciplinary care compared with other types of care are less likely to die (NNT = at 17 months) , or die or be dependent (NNT = 11 at months) .

Langthorne and Duncan: Stroke 2001; 32 : 268-274

Expires November 2003

The study

Systematic review of all randomised trials of

Patients: hospitalised with an acute stroke

Intervention: organised inpatient multidiscplinary care

Outcome: death, dependency, institutionalisation

Articles found in ?all languages using Cochrane Stroke Group Trials Register, (search terms: )

Selection criteria: by 1 reviewer and checked by the other
Appraisal criteria: by 1 independent reviewer and checked by another; using blinding, completeness of follow-up
Articles excluded if:

compared acute stroke care with community care

9 studies found

5 comparing organised multidisciplinary care with no care
3 comparing organised care with multidisciplinary care on a general ward

Studies were found to be heterogeneous.

The evidence

Outcome	Time to outcome	CER	OR (95% CI)	NNT (95% CI)
death	months	135/681 (1938%)	0.66 (0.49 to 0.88)	17 (11 to 51)
death or dependency	months	447/681 (65.6%)	0.68 (0.53 to 0.86)	11 (8 to 29)

Comments

Separate analysis comparing organised care with multidiscplinary care on general wards showed a reduction in mortality, but no clear difference in death or dependency.

Citation

Langthorne P, and Duncan P: does the organisation of postacujte stroke care really matter?. Stroke 2001; 32 : 268-274

Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, November 2001
Reviewer:

_{Clinical Question.}

_Patient	_{acute stroke}
_{Intervention or Exposure}	_{multidiscplinary team care}
_Comparison	_{general ward care}
_Outcome	_{death, dependency}