Nombre de lits dédiés à la pathologie vasculaire cérébrale en soins de suite et de réadaptation. Les recommandations nationales sont-elles pertinentes ? Beds dedicated to stroke patients in postacute care units. Are national guidelines followed?

AbstractObjective. – We sought to determine the number of beds necessary for stroke patients in postacute care units and to measure the relevance ofthe national guidelines on required number of beds.Methodology. – We conducted an epidemiological follow-up of a cohort, what allowed for evaluating stroke care under real-life conditions.We applied the French guidelines for transfer of patients to postacute care wards.Results. – Of the 605 stroke patients hospitalised, 156 with a mean age of 72 years were included. A total of 64 (41%) could return homedirectly from the acute care wards and 73 (47%) were referred to postacute care wards. Among the latter patients, 31 (43%) were transferred to aphysical medicine and rehabilitation (PMR) unit and 42 (57%) to a geriatric unit. The 19 remaining patients died in acute care. Of the 137surviving patients, 46.7% returned directly home and 53.2% were referred to postacute care wards. Of patients older than 80 years, 74% weretransferred to a geriatric unit, whereas 76% of the patients less than 80 years were transferred to a PMR unit.Discussion-conclusion. – The national guidelines are based on a rate of discharge of about 24% of stroke patients to postacute care wards. Inour study, we found that 47% were transferred to such wards. If the guidelines are applied, 19 beds dedicated to stroke patients would benecessary for postacute stroke care on a national level, or double that (36) on a regional level. Of these 36 beds, 16 to 24 should be PMRbeds. The calculation of the number of beds necessary often rests on a simple transposition of the results of the studies and not on an objectiveevaluation according to the local context. Studies of longitudinal follow-up of cohorts such as this seem essential to evaluate needs and measurethe relevance of the national guidelines.© 2006 Elsevier Masson SAS. Tous droits reserves.