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. 2008;25(1-2):12-20.
doi: 10.1159/000111494. Epub 2007 Nov 22.

In-hospital stroke in a statewide stroke registry

Muhammad U Farooq  1 , Mathew J Reeves, Julia Gargano, Susan Wehner, Susan Hickenbottom, Arshad Majid; Paul Coverdell National Acute Stroke Registry Michigan Prototype Investigators
Affiliations

In-hospital stroke in a statewide stroke registry

Muhammad U Farooq et al. Cerebrovasc Dis. 2008.

Abstract

Background: In-hospital stroke (IHS) represents 5-15% of all hospitalized acute stroke cases, and is associated with poor outcomes. IHS represents an important area for prevention since many cases occur in high-risk patients undergoing cardiovascular procedures. Our objectives were to compare the quality of care, treatments, and outcomes of IHS with out-of-hospital stroke (OHS) cases.

Methods: A 6-month prospective cohort of IHS and OHS stroke cases from a statewide acute stroke registry of 15 representative hospitals was assembled. Data were abstracted on demographic, clinical characteristics, in-hospital care (including tPA treatment), discharge instructions, and in-hospital outcomes (mortality and modified Rankin Scale [mRS] at discharge).

Results: 177 (6.5%) of the 2,743 cases in the registry were IHS cases. 40% of IHS cases were admitted with a cardiovascular or neurologically related problem, and 68% underwent an invasive diagnostic or surgical procedure prior to their stroke. IHS cases were less likely to have the cerebral vasculature examined or to have a lipid panel drawn. Compared to OHS, IHS had higher case fatality (14.6 vs. 6.9%; p = 0.04), greater functional impairment (mRS >or=4) (61 vs. 36%; p < 0.001), and were less likely to be discharged home (23 vs. 52%, p < 0.01).

Conclusions: In this prospective registry, 1 in 15 acute stroke cases occurred in the hospital, and almost 70% had an invasive procedure undertaken prior to their stroke event. In-hospital cases received similar quality of care as OHS cases, but had significantly worse outcomes.

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