Evaluation times for patients with in-hospital strokes.

Abstract

Background: Each year at least 35 000 people suffer a stroke while hospitalized, but little is known about the clinical characteristics of such patients or how rapidly they are identified and evaluated. With a recent emphasis on the very early treatment of stroke, in-hospital stroke patients may be candidates for some early interventions.Methods: This was a retrospective study using the stroke registries at two academic medical centers. Data were collected about the clinical characteristics of patients with an in-hospital stroke and who recognized the stroke. Detailed time data were analyzed to determine the time of stroke recognition, medical evaluation, and neurological evaluation. These specific time epochs were analyzed to determine which were responsible for any delays in stroke identification and assessment. Data were analyzed using nonparametric methods, including the Wilcoxon rank sum and Kruskal-Wallis procedure.

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

“…Therefore, patients who are being admitted to a hospital due to diseases other than stroke may have a stroke during their hospitalization (in-hospital stroke; IHS). It is known that IHS accounts for about 6.5-8.7% of the total number of strokes [1,2]. Previous studies have identified patients with IHS from the hospital-based stroke registry [3,4] or have investigated the association of specific procedures or surgeries with risk of stroke [5,6].…”

“…In previous studies, there were substantial delays between symptom recognition, neurological assessment, and i.v. rt-PA treatment when stroke developed during hospitalization [1,29].To speed up the recognition and assessment of IHS patients, education and training are required for nursing staffs and physicians. However, when considering the complexity of practice, diversity of co-morbid diseases, and number of potential trainees to be educated or trained in a hospital, the implementation of an entire hospital-wide activation system for stroke occurrence is presumably difficult or may be ineffective.…”

In-hospital stroke

“…Most ischemic IHS occur on cardiological or cardiosurgical wards 11 after coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) 9,12 or, more generally, after invasive procedures (70%) 13 . Accordingly, most patients with IHS are hospitalized because of myocardial infarction (MI) or CABG 14 .…”

“…Stroke etiology according to TOAST criteria 15 is more often reported to be cardioembolic or undetermined in comparison to COS 12,14 . Inflammation, diabetes, dehydration, hypertension or instable blood-pressure, reduced renal function, reduced left ventricular ejection faction, newly detected atrial fibrillation and previous MI or stroke have been described as independent risk factors for IHS [16][17][18][19][20] .…”

“…While in COS patients symptoms are usually recognized by spouses or relatives, IHS is most often recognized by medical personnel (80%), especially nurses (64%) 14 . In case of an emergency call, COS are usually taken to the emergency department by emergency medical services, where they are neurologically evaluated and immediately treated 27 .…”