Poster Presentation Australian and New Zealand Stroke Organisation Conference 2025

What do acute stroke units look like across the globe? A descriptive snapshot from an international acute mobility trial (AVERT DOSE) (#109)

Lilian Carvalho 1 , Fiona Ellery 1 , Ruby Lipson Smith 1 2 , Anna Urokohara 1 , Leonid Churilov 3 , Julie Bernhardt 1
  1. The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
  2. The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, Sydney, NSW
  3. University of Melbourne, Melbourne, VIC

Background/Aims

AVERT DOSE1 is an ongoing global clinical trial to determine the optimal acute mobility training in mild/moderate ischaemic stroke. We aim to describe the demographics of stroke units involved in the trial and explore differences in provision of stroke care across the varied geographical regions.  

Methods

A survey of 46 questions was developed based on current knowledge of stroke unit design, provision of care and advice from design experts. The survey was disseminated to 50 principal site investigators (7 countries) via REDCap® Questions.

Results

By April 2025, 47 sites responded to the survey from Australia (13), Asia (2 Malaysia, 2 Singapore, 7 India), UK (10), Ireland (3), and Brazil (10). Mean number of hospitals’ dedicated stroke beds varied between 10(SD5) in Ireland and 33(SD12) in the UK. Average length of stay reported was of 11.7(4.8) days in the UK, and 25.5(0.7) days in Singapore. All sites reported having immediate CT access and thrombolysis. 57% (27) had onsite neurosurgery. Thrombectomy was not available in 11 sites in UK/Ireland, 2 Asia, 4 Brazil, and 7 Australia. Only 30% (14) sites had >2 physiotherapists, 7 located in England. Most sites reported having a nurse-to-patient ratio between 1:2 to 1:6, except for 2 British sites (1:7 and 1:8) and 7 Brazilian sites (1:7 to 1:12). To support nurses, 6 British sites had more allied health assistants (>3 staff), but only 3 Brazilian sites had >3 allied health assistants.

Conclusion

Despite international agreement on what constitutes a stroke unit, there is considerable variation globally.

  1. 1 Bernhardt, J., Churilov, L., Dewey, H., et al. (2023). A phase III, multi-arm multi-stage covariate-adjusted response-adaptive randomized trial to determine optimal early mobility training after stroke (AVERT DOSE). International Journal of Stroke, 18(6), 745-750. https://doi.org/10.1177/17474930221142207