Is stroke unit care portable? A systematic review of the clinical trials

Background: it is not known if mobile stroke teams can achieve the good results seen in trials of geographically discrete stroke wards (stroke units). Objective: to establish the effectiveness of mobile stroke teams. Design: systematic review of controlled clinical trials that compared peripatetic systems of organised stroke care (stroke team care) with alternative hospital services. Methods: systematic review and meta-analysis (using Cochrane Collaboration methodology and involving the primary trialists). Clinical outcomes included death, dependency, the need for institutional care and measures of the process of care such as the delivery of key investigations and treatments. Results: six clinical trials (1,085 patients) were identified; five (781 patients) compared some form of stroke team care with conventional care in general medical wards and one (304 patients) compared team care with a comprehensive stroke unit. Compared with care in general wards, stroke team care improved some aspects of the process of care, but clinical outcomes were similar. Compared with a comprehensive stroke unit, stroke team patients were significantly less likely to survive (P< 0.001), return home (P< 0.001) or regain independence (P< 0.0001). Most aspects of the process of care were also poorer than in the stroke unit. Conclusions: care from a mobile stroke team had no major impact on death, dependency or the need for institutional care.