In-Hospital Ischemic Stroke

Abstract

Between 2.2% and 17% of all strokes have symptom onset during hospitalization in a patient originally admitted for another diagnosis or procedure. These in-hospital strokes represent a unique population with different risk factors, more mimics, and substantially worsened outcomes compared to community-onset strokes. The fact that these strokes manifest during the acute care hospitalization, in patients with higher rates of thrombolytic contraindications, creates distinct challenges for treatment. However, the best evidence suggests benefit to treating appropriately selected in-hospital ischemic strokes with thrombolysis. Evidence points toward a ''quality gap'' for in-hospital stroke with longer in-hospital delays to evaluation and treatment, lower rates of evaluation for etiology, and decreased adherence to consensus quality process measures of care. This quality gap for in-hospital stroke represents a focused opportunity for quality improvement.

Clinical features and biological markers of lung cancer-associated stroke

“…Cerebral infarction is a potentially fatal condition with a very short therapeutic window, 24 , 25 and identification of its aetiology is critical to the successful management of this disease. 26 The short therapeutic window means that the early detection of cerebral infarction is of critical importance, 27 especially when it occurs in a patient with a malignancy.…”

Invasive Pneumococcal Disease: Still Lots to Learn and a Need for Standardized Data Collection Instruments

“…From 2.2 to 17% of all strokes have onset during hospitalization for a diagnosis or procedure other than stroke [39]. In a systematic review of trigger factors for ischemic stroke, Guiraud et al found that infection within the previous week was such a trigger factor with odds ratio of 2.91 (1.41–6) and respiratory tract infection had odds ratio of 2.4 (1.2–4.8) [40].…”

In-hospital stroke

“…By doing so, the median time from symptom recognition to CT could be reduced radically (74min compared to 271min before the implementation) 41 . The goal of a protocol-driven approach is to create unambiguous responsibilities and to perform tasks simultaneously instead of sequentially whenever possible (detailed pocket-card by E. Cumbler) 42 .…”