New studies have shown analysts that England and Wales need to have dedicated stroke units in urban areas to help save the lives of patients.
An estimated 125,000 people suffer a stroke in England each year. Approximately 40,000 of these patients die from a stroke as a result.
A stroke occurs when the blood supply to part of the brain is cut off. This is caused by a blockage in one of the blood vessels which lead to the brain. Typical symptoms include paralysis down one side of the body, sudden loss of vision and dizziness as well as difficulty in communicating.
Time is critical in treating those who have had a stroke. The Department of Health’s National Stroke Strategy has recommended a shake up to the care of stroke patients. They want to improve the outcomes for all stroke sufferers. They identified that care in a specialised stroke unit can improve the outcomes for stroke patients. Many other countries, such as Australia and the United States, already offer centralised specialist stroke units which showed this type of system can help.
In 2010 London and Greater Manchester both took part in a trial of this system. London would take all stroke patients whereas Greater Manchester helped those who had suffered a stroke no more than 4 hours before admission. Hub hospitals were chosen in each area for them to become the specialist unit where all patients would be taken during their first 72 hours of a stroke. In London this allowed the stroke services (across eight units) were now available 24/7 to allow for immediate brain imaging, thrombolysis ( also known as “clot busting”) and specialist care. 28 further units were designated as rehabilitation units across London. 5 units were shut down as a result.
The scene was different in Greater Manchester. Due to the longer travelling distances the immediate care for brain scans and thrombolysis was available to those who had suffered a stroke no more than 4 hours previously. All other patients were taken to one of 10 stroke centres for post-thrombolysis stroke care. No hospital units were shut down as a result of this study. The performance of these centres were analysed over a 51 month period (before and after the changes to enable a difference to be seen).
During this time data was available to show there were 17,650 patients in Greater Manchester and 33,698 in London. The study was looking at mortality rate and length of stay in hospital following a stroke.
In order to see how the changes came into effect data was collected throughout England as well as the study areas of London and Greater Manchester.
During the study it was found that the death rate and length of stay in hospital fell in Greater Manchester and London. Overall, this was the same throughout hospitals in England. However, the risk of death within the first 3 days of a stroke was significantly reduced in London. This rose again at the 30 days post stroke and again at 90 days post stroke. In terms of patient numbers the centre in London appeared to reduce the death of 146 patients at 3 days, 194 deaths at 30 days post stroke and 168 deaths 90 days post stroke.
Unfortunately the death rates in Manchester were not significantly different to those seen across the rest of England throughout the study period.
In regards to the length of hospital stay there was a significant decline in both study areas compared to the rest of the England. There was a reduction of 2 days in Greater Manchester (9% less stay) and 1.4 days on London (7% less stay). In terms of the care overall this meant that Greater Manchester had 17, 685 fewer hospital days and London had 22, 341 fewer hospital days. This would help many patients in their recovery.
The data shows there is a clear difference between the two different models that were used in London (24/7 care for all patients) and that used in Greater Manchester (those who had a stroke within 4 hours).
The studies have shown that a centralised stroke unit which specialises in the emergency care of strokes across the country would reduce deaths from a stroke and the amount of time spent in hospital following the stroke.
It is now for others to decide if this model is put into force throughout England and Wales.
In order for patients who have suffered a stroke to receive the best possible outcome they need fast treatment. Access to treatment such as a thrombolysisis key to their long term recovery. Rehabilitation allows a stroke patient to recover as much of their life back as is possible and referrals for this need to be done quickly.
If you believe you or a loved one has been affected by delayed or poor treatment following a stroke please contact us on 0161 615 5554 to discuss how we can help.