[In-hospital stroke: clinical profile and expectations for treatment]

Abstract

Introduction: In-hospital strokes have been poorly reported. They provide an opportunity to shorten intervals for thrombolysis. Our proposals were: a) to describe their clinical features and neurological assessment, and b) regarding thrombolysis, to analyze potential candidates and exclusions at a general tertiary hospital, just before its approval/implementation at the center.

Methods: Cases were retrospectively recruited between May 2001-May 2004. They were identified from discharching diagnosis (ICD-9: 430-439; GRD: 14, 15, 16, 17, 532, 810) and from consultations required to the neurology service. Data collected were: a) admitting diagnosis and service; b) mechanism of stroke (Trial of Org 10172 in Acute Stroke Treatment, TOAST) and clinical syndrome (Oxfordshire Community Stroke Project, OCSP); c) vascular risk factors and previous symptomatic artherioesclerotic disease (PSAD), and d) prognosis, functional status at discharge (mRankin scale, mRS) and timing for neurological assessment. Every case was considered regarding thrombolytic treatment according to Safe Implementation of Trombolysis in Stroke-Monitoring Study (SIST-MOST) criteria. Potential criteria for exclusion were registered.

Results: 183 cases were included (26 transient ischemic accident, 149 ischemic strokes, 5 haemorrhages). Mean age: 74.5 years, 25.5%, above 80 years. Main sources of patients were cardiology plus related services (31.8%) and internal medicine (18%). Dominant mechanism was cardioembolism (40%). 18 cases (11.77%) were yatrogenic. 55.8% had had PSAD (stroke: 41; ischemic cardiopathy: 31). Mortality reached 33%. 36% were discharged pointing 3 or above in the mRS. Expert neurological assessment was requested in 89%, but just for 25% it was considered an emergency. From 149 ischemic strokes, 5 cases (3.2%) were potential candidates for thrombolysis. Mayor surgery, ageing (>80 years), severe acute disorders or combinations of them precluded thrombolysis.

Conclusions: In-hospital strokes are particularly prevalent in patients with PSAD. Prognosis is poor. In 3.2% thrombolysis could be administered. To make this possible, a right perception of the timing and emergency should be encouraged among hospital staff.