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Stroke Unit – Evidence Base — SCE Neurology MCQ

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EasyCerebrovascular DiseaseStroke Unit – Evidence BaseSCE Neurology

A 65-year-old man is admitted to the stroke unit with a right MCA territory ischaemic stroke. His NIHSS is 14. He was not eligible for thrombolysis or thrombectomy. What evidence supports admission to a specialist stroke unit rather than a general medical ward?

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Correct answer: E — Organised stroke unit care reduces mortality, dependency, and institutionalisation compared with care on a general ward — this is one of the most robustly evidenced interventions in stroke medicine

The Stroke Unit Trialists' Collaboration Cochrane review (multiple updates) has consistently shown that organised stroke unit care reduces mortality (by ~20%), dependency, and need for institutional care compared with general medical ward care. This benefit applies across all stroke types and severities, and is independent of thrombolysis or thrombectomy. Key components include: MDT care (nursing, physiotherapy, OT, SLT, dietetics), early mobilisation, protocol-driven management of complications, and secondary prevention. A: There is very strong evidence. C: All stroke severities benefit. D: Both ischaemic and haemorrhagic strokes benefit. E: The benefit is independent of acute reperfusion therapy.

Reference: Stroke Unit Trialists' Collaboration Cochrane Review; NICE NG128