はじめに 40: , 要旨 Stroke Care Unit SCU SCU. NIHSS mrs. Key words: stroke care unit, acute stroke, outcome, community hospital SU/SCU A SU/SCU

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1 40:414 原 著 40: , 要旨 Stroke Care Unit SCU NIHSS mrs p<0.05 NIHSS tpa mrs 0 2 Key words: stroke care unit, acute stroke, outcome, community hospital はじめに Stroke Unit: SU Stroke Care Unit: SCU doi: /jstroke SU/ 14 A SU/ ADL SU/ SU 10, 11 SU ICU SU

2 SCU installation in Japanese Community Hospital 40: SU/ 2012 症例と方法 SCU BAD branch atheromatous disease 3 SCU NI- HSS modified Rankin Scale: mrs R ver EZR ver χ 2 NIHSS Kruskal-Wallis Bonferroni mrs Kruskal-Wallis mrs 0 2 mrs χ 2 Bonferroni mrs 0 2 NIHSS 95 結果 Table NIHSS SCU 50

3 40:416 脳卒中 χ 2 p=0.72 p=0.72 χ 2 p=0.63 NIHSS Kruskal-Wallis p=0.66 Table 2 p=0.01 Bonferroni p< Table 1 Summary of demographic and clinical data of acute stroke patients before and after SCU installation p NE NE NIHSS : chi-squared test, : one-way analysis of variance, : Kruskal-Wallis test NE: not examined Table 2 Outcome measures and their comparison between before and after SCU installation p tpa NE tpa NE SD # NE NE mrs <0.001 mrs : chi-squared test, : one-way analysis of variance, : Kruskal-Wallis test #,,, : p<0.01 with Bonferroni correction, as compared with before SCU installation (2011). NE: not examined

4 SCU installation in Japanese Community Hospital 40:417 mrs Table 2 Fig. 1a Kruskal-Wallis p<0.001 Bonferroni p<0.001 mrs 0 2 Table 2 Fig. 1b χ 2 p=0.001 Bonferroni p< p= p<0.001 考察 a b Fig. 1 a mrs p<0.001 Kruskal-Wallis test b mrs 0 2 mrs 3 5 p=0.001 χ 2 test p<0.001 with Bonferroni correction

5 40:418 脳卒中 ADL SCU Stroke Unit Care SU 20 S.S. SCU SCU 15 8 SU SU 3 16 tpa Inoue 17 DPC Diagnosis Procedure Combination 2010 SCU SC/ SU/ SU/ 23 SU/SCU SU/ SU 13 SCU mrs SU/SCU SU/ 24 26

6 SCU installation in Japanese Community Hospital 40:419 結 42 論 COI COI 参考文献 nengai11/index.html access access 3 Molyneux AJ, Birks J, Clarke A, et al: The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 385: , Lees KR, Emberson J, Blackwell L, et al: Effects of alteplase for acute stroke on the distribution of functional outcomes: a pooled analysis of 9 trials. Stroke 47: , Goyal M, Menon BK, van Zwam WH, et al: Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387: , Indredavik B, Bakke F, Solberg R, et al: Benefit of a stroke unit: a randomized controlled trial. Stroke 22: , Indredavik B, Bakke F, Slørdahl SA, et al: Stroke unit treatment improves long-term quality of life: a randomized controlled trial. Stroke 29: , Candelise L, Gattinoni M, Bersano A, et al: Stroke-unit care for acute stroke patients: an observational follow-up study. Lancet 369: , Langhorne P, Williams BO, Gilchrist W, et al: Do stroke units save lives? Lancet 342: , Stroke Unit Trialists Collaboration: Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 314: , Stroke Unit Trialists Collaboration: How do stroke units improve patient outcomes? A collaborative systematic review of the randomized trials. Stroke 28: , Govan L, Langhorne P, Weir CJ, et al: Does the prevention of complications explain the survival benefit of organized inpatient (stroke unit) care?: further analysis of a systematic review. Stroke 38: , Seenan P, Long M, Langhorne P: Stroke units in their natural habitat: systematic review of observational studies. Stroke 38: , Stroke Care Unit SCU Stroke Unit SU pp stroke unit stroke unit 29: 59 64, stroke care unit Neurosurg Emerg 14: 42 46, Inoue T, Fushimi K: Stroke care units versus general medical wards for acute management of stroke in Japan. Stroke 44: , Kanda Y: Investigation of the freely available easy-to-use software EZR for medical statistics. Bone Marrow Transplant 48: , Rohweder G, Ellekjær H, Salvesen Ø, et al: Functional outcome after common poststroke complications occurring in the first 90 days. Stroke 46: 65 70, Langhorne P, Pollock A; Stroke Unit Trialists Collaboration: What are the components of effective stroke unit care? Age Ageing 31: , hw/iryosd/14/dl/gaikyo.pdf access 22 Cadilhac DA, Purvis T, Kilkenny MF, et al: Evaluation of rural stroke services: does implementation of coordinators and pathways improve care in rural hospitals? Stroke 44: , Tamm A, Siddiqui M, Shuaib A, et al: Impact of stroke care unit on patient outcomes in a community hospital. Stroke 45: , Walter A, Seidel G, Thie A, et al: Semi-intensive stroke unit versus conventional care in acute ischemic stroke or TIA a prospective study in Germany. J Neurol Sci 287(1 2): , Bray BD, Ayis S, Campbell J, et al: Associations between the organisation of stroke services, process of care, and mortality in England: prospective cohort study. BMJ 346: f2827, Turner M, Barber M, Dodds H, et al: The impact of stroke unit care on outcome in a Scottish stroke population, taking into account case mix and selection bias. J Neurol Neurosurg Psychiatr 86: , 2015

7 40:420 脳卒中 Abstract Clinical indicators before and after equipment of stroke care unit in community hospital Mika Bando, 1) Chisa Hirayama, 1) Yuhino Ikeda, 1) Mizuki Kino, 1) Haruka Tomita, 1) Miyuki Iso, 1) Miki Hayashi, 1) Yoko Tazuke, 1) Shintaro Sugiyama, 1) Takeshi Satow, M.D., Ph.D., 2) Taro Komuro, M.D., Ph.D., 2) Masafumi Ogawa, M.D., Ph.D., 3) and Akira Kobayashi, M.D., Ph.D. 2) 1) Department of Nursing Service, Nagahama City Hospital 2) Department of Neurosurgery, Nagahama City Hospital 3) Department of Neurology, Nagahama City Hospital Background and Purpose: It is well known that Stroke Care Unit (SCU) is effective for improving clinical outcomes of stroke patients. In Japan, SCU is installed in limited hospitals. However, its efficacy has rarely been reported. We compared the clinical outcomes of acute stroke patients in a community hospital in Japan between before and after SCU installation. Methods: From April 2011 to March 2016, acute stroke patients admitted to Neurology/Neurosurgery department in Nagahama City Hospital were enrolled. Age, gender, stroke types, NIHSS on admission, the number of tpa thrombolysis, length of stay in acute care ward, in-hospital mortality, the rate of home discharge, and modified Rankin Scale on discharge of each fiscal year were retrospectively recorded from the medical chart. Parameters of each patient for 2013, 2014, and 2015 were compared with control (those of 2011), by means of chi-squared test, Kruskal-Wallis test, or one-way analysis of variance as appropriate. Bonferroni correction was used as a post hoc comparison. P value less than 0.05 was deemed as significant. Results: Demographic and clinical data of patients did not differ among every year. The number of tpa thrombolysis tended to increase after SCU installation. Length of stay in acute care ward decreased after SCU installation. The rate of discharge home tended to increase after SCU installation. In-hospital mortality finally decreased after SCU installation. mrs 0 2 on discharge has a tendency to increase after SCU installation. Conclusion: Even if a community hospital in Japan was equipped with SCU, clinical outcomes of acute stroke patients tended to improve. Key words: stroke care unit, acute stroke, outcome, community hospital (Jpn J Stroke 40: , 2018)