Comparison of the characteristics for in‐hospital and out‐of‐hospital ischaemic strokes

Abstract

Background and purpose: Patients who are being admitted to a hospital due to diseases other than stroke may develop a stroke (in-hospital stroke; IHS). Methods: We enrolled 111 consecutive patients who developed IHS outside a neurology ward during a 5-year period at a single hospital. The frequency, characteristics, and outcomes for IHS patients were compared with patients who develop ischaemic stroke outside of the hospital (out-of-hospital stroke; OHS). Results: Forty-six percent of IHS occurred in the department of cardiology or cardiovascular surgery and 60% were associated with surgery or procedures. In comparison with the OHS patient group, the IHS patient group showed an increased frequency of cardiac disease, leukocytosis, and anemia. Cardioembolism, stroke of other determined etiologies, and an incomplete evaluation were more common in the IHS group, whereas large artery atherosclerosis was more frequent in the OHS group. The IHS group had up to a 10-fold higher mortality than the OHS group, with sepsis being the most common cause of death in the IHS group. Conclusions: IHS has distinct etiologies and stroke mechanisms from OHS. The prevention and management of infection could decrease mortality in IHS patients.

In-Hospital Ischemic Stroke

“…5 Half of periprocedural events occur in the first 24 hours of surgery or invasive procedure. 10 Two-thirds of in-hospital strokes are witnessed at symptom onset, most commonly by a nurse. 15,17 Across a variety of studies, cardiac risk factors are more frequently observed in patients with in-hospital stroke including atrial fibrillation, coronary artery disease, and congestive heart failure/cardiomyopathy.…”

“…2,3,6,8,10 Conversely, atherosclerotic risk factors such as hypertension and tobacco use appear to be more common in community-onset strokes. 3,6,8,10 Transient ischemic attacks appear to be less commonly reported as manifestation of in-hospital ischemia. 5 In-hospital strokes have a greater severity in general, but the lower observed rates of TIA may also be influenced by impaired ability to recognize transient ischemic symptoms in complex ill inpatients with plausible alternative explanations for symptoms.…”

Quality of Care and Outcomes for In-Hospital Ischemic Stroke

“…1,11 However, smaller studies of patients with in-hospital stroke have reported use of IV tPA for 2.6% to 13.7% of inhospital strokes. 1,6,8,11 Our study suggests such IV thrombolysis, for appropriately selected in-hospital strokes, does not carry increased risk for symptomatic intracranial hemorrhage. Our data are the first to suggest that time to treatment significantly differs between in-hospital and community-onset strokes with median difference in time to IV tPA of 24 minutes between groups.…”

“…Previous studies suggest that in-hospital strokes are more severe and have worse outcomes than strokes occurring in the community. 1,5,6,8,9 However, there are few previous studies of in-hospital stroke quality of care and none at the national level. 6,[10][11] The purpose of this study was to analyze quality of care and clinical outcomes for in-hospital acute ischemic strokes using the national Get With The Guidelines-Stroke (GWTG-Stroke) registry of the American Heart Association (AHA)/American Stroke Association (ASA).…”

“…6,7,18,20 Nearly one quarter of patients with in-hospital stroke are admitted with cardiovascular illness, and many occur postoperatively, particularly after cardiac valve, head and neck, or vascular surgery. 6,8,17,[21][22][23] Multiple concurrent acute illnesses may create conflicting priorities in care and interact in a complex fashion on adherence to disease-specific quality metrics. The presence of interacting acute illnesses may increase the chance that select quality metrics such as the intensity of statin therapy or assessment for rehabilitation needs will be met for patients with in-hospital stroke.…”