Delays in Recognition, Treatment of In-Hospital Stroke

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Patients who suffer from stroke while in a hospital setting actually fair worse than those with community-onset stroke, according to findings published in JAMA Neurology.

Alexandra P. Saltman, MD, of the University of Toronto, and colleagues examined stroke care delivery and outcomes for patients with in-hospital vs. community-onset stroke, as a minority of strokes occur in-hospital but little is known about care and outcomes in this population.

The researchers compared time to neuroimaging, rates of thrombolysis, and outcomes including death and disability in a sample of 973 in-hospital stroke patients and 28,837 community-onset stroke patients from regional stroke centers in Ontario, Canada between July 1, 2003 and March 31, 2012. Outcomes were adjusted for age, sex, comorbid conditions, stroke type, and stroke severity.

Compared to those who had community-onset stroke, in-hospital stroke patients had significantly longer wait times from symptom recognition to neuroimaging  (median, 4.5 vs. 1.2 hours; P < .001; for <2 hours, 32% vs 63%; adjusted odds ratio [AOR] = 0.21; 95% CI, 0.18-0.24), lower use of thrombolysis (12% vs. 19% of those with ischemic stroke; AOR = 0.54; 95% CI, 0.43-0.67; P < .001), and longer time from stroke recognition to administration of thrombolysis (median, 2.0 vs. 1.2 hours; P < .001).

Stroke severity and other factors, mortality rates at 30 days and one year post-stroke were similar in both populations after adjustment for age, however in-hospital stroke patients had a longer length of stay after stroke onset (17 vs. 8 days; P < .001), were more likely to be dead or disabled at discharge  (77% vs. 65% with modified Rankin Scale score of 3-6; AOR = 1.64; 95% CI, 1.38-1.96; P < .001), and were less likely to be discharged home from hospital care (35% vs. 44%; AOR = 0.76; 95% CI, 0.64-0.90;P < .001) than community-onset patients.

The findings suggest that hospital environments need to establish a more standardized approach to the recognition and management of in-hospital stroke to provide rapid access to acute stroke care. 

Elderly man in hospital bed
Delays in Recognition, Treatment of In-Hospital Stroke

A sizeable minority of strokes occur in hospitalized patients. However, little is known about the presentation, care, and outcomes of stroke in this subgroup of patients.

Alexandra P. Saltman, MD, of the University of Toronto, and colleagues compared processes of stroke care delivery, including time to neuroimaging and rates of thrombolysis, as well as outcomes, including death and disability, in those with in-hospital vs community-onset stroke. We used multiple logistic regression models to adjust for age, sex, comorbid conditions, and stroke type and severity.

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