Revisión: el alta temprana apoyada puede reducir la duración de la hospitalización en pacientes con accidente cerebrovascular agudo, pero no reduce la muerte.

QUESTION:

In patients admitted to hospital with acute stroke, do early supported discharge (ESD) services accelerate return to home, improve patient outcomes, and reduce resource use?Data sourcesStudies were identified by searching the Cochrane Stroke Group Specialised Register of Controlled Trials in April 2001 (which includes studies identified through searches of Medline, EMBASE/Excerpta Medica, BIOSIS, DERWENT Drug File, SCISEARCH, and other databases; and handsearches of selected journals, conference proceedings, and books) and by contacting trialists.Study selectionRandomised controlled trials (RCTs) of patients with stroke were included if they compared conventional hospital discharge procedures with alternative services that aimed to accelerate patient discharge from hospital by providing rehabilitation and/or physical support in community settings (ie, ESD).Data extractionData were extracted on methods, participants, interventions, and outcomes. Main outcomes were death, place of residence, and physical dependency. Secondary outcomes included, among others, resource outcomes such as length of hospital stay and readmissions. Methodological quality of individual trials was assessed (concealment of allocation, intention to treat analysis, and blinding of outcome assessors).Main resultsOf the 9 trials that met the selection criteria, primary outcome data were only available for 4 (n=757, mean/median age ranged from 71-75 y). 3 trials involved units with a coordinated ESD team, which both planned and provided care, whereas the fourth trial had no coordinated ESD team, with care being planned and provided by a range of community stroke services. All 4 trials had concealed allocation to groups and blinded outcome assessment; follow up ranged from 92% to 98%. Meta-analysis of these 4 trials showed that the ESD and conventional care groups did not differ for death, combined death or institutional care, or combined death or dependency (table). Patients in the ESD group had a shorter initial hospital stay than the conventional care group (4 trials, n=741, weighted mean difference -15 d, 95% CI -24 to -6), but did not differ for readmissions (2 trials, n=423, 22% v 22%).ConclusionIn patients admitted to hospital with acute stroke, early supported discharge may reduce length of initial hospital stay, but does not reduce death, combined death or institutional care, or combined death or dependency.