Actual Circumstances of In-hospital Stroke Set-up Using Rapid Response System for Stroke in the Endovascular Thrombectomy Era

Abstract

With the widespread adoption of mechanical thrombectomy, the public expects an increasingly high level of stroke care. This study aimed to investigate the current status of in-hospital stroke following the initiation of a "Stroke Call," which is a Rapid Response System for stroke. We analyzed 330 consecutive cases of "Stroke Call" among 110,142 patients hospitalized at our institute from June 2017 onward. Of the 330 patients, 187 (56.6%) had confirmed stroke and 143 (43.3%) had stroke mimics. Data on age, sex, use of antithrombotic agents, perioperative status, presence of cancer, department, hospitalization ward, and the identity of the calling staff were obtained from admission records. Multivariate analysis of risk factors for real stroke and diagnostic delays showed that stroke was significantly associated with the use of antithrombotic agents, departments with a higher frequency of "Stroke Call" (>5 cases) and calls initiated by medical doctor staff, while diagnostic delays were significantly associated with the departments with a lower frequency of "Stroke Call" (≤5 cases), hospitalization in the intensive care unit, and a history of hypertension. Among ischemic stroke cases, 61 (32.6%) occurred during the perioperative period, and 88.3% occurred within 7 days postoperatively. In conclusion, our study highlights the clinical characteristics, management challenges, and risk factors associated with in-hospital stroke in our hospital and offers valuable insights for improving in-hospital stroke care. In-hospital stroke is a frequent occurrence and requires sustained awareness campaigns and systemic intervention by the healthcare insurance system.

Keywords: in-hospital stroke; ischemic stroke care; mechanical thrombectomy; rapid response system; stroke mimics.