In‐hospital stroke: a multi‐centre prospective registry

Vera, Rocío; Lago, Aída; Fuentes, Blanca; Gállego, J.; Tejada, J.; Casado, I.; Purroy, Francisco; Delgado, Pilar; Simal, Patricia; Martí‐Fàbregas, Joan; Vivancos, José; Fernando, Daniel; Freijo, Mar; Masjuán, Jaime

doi:10.1111/j.1468-1331.2010.03105.x

Cited by 59 publications

(60 citation statements)

References 16 publications

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“…It has been suggested that ≤15% of IHS cases suitable for thrombolysis were denied treatment because of delays in diagnosis. 6 Public awareness of stroke symptoms has improved in the past decade owing to ongoing public education initiatives 7 ; however, there are limited data examining stroke knowledge among hospital staff. Analysis of US stroke registry data highlighted that evaluation times for IHS remains twice the recommended times, and further investigation of the reasons for these delays in IHS is needed.…”

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confidence: 99%

Knowledge of Thrombolytic Therapy Amongst Hospital Staff

Mellon

Hasan

Lee

et al. 2015

Stroke

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Background and Purpose— In-hospital stroke is associated with slower access to thrombolysis than community-occurring stroke. It has been suggested that lack of knowledge regarding appropriate stroke response among hospital staff may contribute to delays in referral, assessment, and treatment of in-hospital stroke. Method— A survey was conducted among hospital ward staff members using the Stroke Awareness Questionnaire, which was adapted for use among hospital staff to assess their knowledge of stroke symptoms, acute treatments, and hospital protocols for treatment of stroke. Results— Ninety-six staff members were interviewed, 81% of whom were clinical staff (medical, nursing, allied health professionals). Ninety-two percent of staff could name ≥3 stroke symptoms. Only 49% of staff were aware of thrombolysis treatment, and only 48% could identify the time window for thrombolysis administration, with staff from stroke-related specialties likely to name thrombolysis as an acute treatment for stroke (71%; odds ratio =3.36, 95% confidence interval 1.17–9.61) and identify the correct treatment window (71%; odds ratio =3.55, 95% confidence interval 1.24–10.16). Only 52% of staff on general wards were aware of an in-hospital stroke protocol. Conclusions— Hospital staff had adequate knowledge of stroke signs and symptoms; however, there was low awareness of thrombolysis therapy and its correct treatment time window among hospital staff. Targeted educational programmes among hospital staff regarding stroke are required to optimize acute stroke care.

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confidence: 99%

Knowledge of Thrombolytic Therapy Amongst Hospital Staff

Mellon

Hasan

Lee

et al. 2015

Stroke

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“…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.…”

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confidence: 99%

Quality of Care and Outcomes for In-Hospital Ischemic Stroke

Cumbler

Wald

Bhatt

et al. 2014

Stroke

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Background and Purpose-Analysis of quality of care for in-hospital stroke has not been previously performed at the national level. This study compares patient characteristics, process measures of quality, and outcomes for in-hospital strokes with those for community-onset strokes in a national cohort. Methods-We performed a retrospective cohort study of the Get With The Guidelines-Stroke (GWTG-Stroke) database ofThe American Heart Association from January 2006 to April 2012, using data from 1280 sites that reported ≥1 in-hospital stroke. Patient characteristics, comorbid illnesses, medications, quality of care measures, and outcomes were analyzed for 21 349 in-hospital ischemic strokes compared with 928 885 community-onset ischemic strokes. Results-Patients with in-hospital stroke had more thromboembolic risk factors, including atrial fibrillation, prosthetic heart valves, carotid stenosis, and heart failure (P<0.0001), and experienced more severe strokes (median National Institutes of Health Stroke Score 9.0 versus 4.0; P<0.0001). Using GWTG-Stroke achievement measures, the proportion of patients with defect-free care was lower for in-hospital strokes (60.8% versus 82.0%; P<0.0001). After accounting for patient and hospital characteristics, patients with in-hospital strokes were less likely to be discharged home (adjusted odds ratio 0.37; 95% confidence intervals [0.35-0.39]) or be able to ambulate independently at discharge (adjusted odds ratio 0.42; 95% confidence intervals [0.39-0.45]). In-hospital mortality was higher for in-hospital stroke (adjusted odds ratio 2.72; 95% confidence intervals [2.57-2.88]). Conclusions-Compared with community-onset ischemic stroke, patients with in-hospital stroke experienced more severe strokes, received lower adherence to process-based quality measures, and had worse outcomes. These findings suggest there is an important opportunity for targeted quality improvement efforts for patients with in-hospital stroke.

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“…[1], [4] Although additional co-morbidities, metabolic or haematological derangements and greater stroke severity in IHS patients are major contributors to poor outcomes, [5] many studies have suggested that delays in recognition, referral, specialist assessment and thrombolysis may also play an important role. [6], [7] Findings suggest that only 25%–50% of in-hospital stroke (IHS) patients are assessed within 3 hours of symptom onset despite already being in a hospital, [6], [7] and 15% of IHS patients may be denied thrombolysis because of these delays. [6] This is important as studies show that the safety and 90 day outcomes of thrombolysis of IHS patients are similar to those who present from outside hospital to emergency departments [8].…”

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confidence: 99%

The Impact of Early Specialist Management on Outcomes of Patients with In-Hospital Stroke

2014

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Delays in treatment of in-hospital stroke (IHS) adversely affect patient outcomes. We hypothesised that early referral and specialist management of IHS patients will improve outcomes at 90 days. Baseline characteristics, assessment delays, thrombolysis eligibility, 90-day functional outcomes and all-cause mortality were compared between IHS patients referred for specialist stroke management within 3 hours of symptom onset (early referrals) and later referrals. Patients were identified from a prospective stroke registry between January 2009 and December 2010. Inclusion criteria were primary admission with a non-stroke diagnosis, onset of new neurological deficits after admission and early ischaemic changes on CT or MR imaging. Eighty four (4.6%) of 1836 stroke patients had IHS (mean age 74 year; 51% male, median NIHSS score 10). There were no significant differences in baseline characteristics between 53 (63%) early and 31 (37%) late referrals. Thrombolysis was performed in 29 (76%) of the 37/78 (47%) potentially eligible patients; 7 patients were excluded because specialist referral was delayed beyond 4.5 hours despite symptom recognition within 3 hours of onset. Early referral improved functional outcomes (modified Rankin Scale 0–2 at 90 days 40% v 7%, p = 0.001) and was an independent predictor of mRS 0–2 at 90 days after adjusting for age, pre-morbid function, primary cause for hospital admission and stroke severity [OR 1.13 (95% C.I. = 1.10–1.27), p = 0.002]. Early referral and specialist management of IHS patients that includes thrombolysis is associated with better functional outcomes at 90 days.

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In‐hospital stroke: a multi‐centre prospective registry

Cited by 59 publications

References 16 publications

Knowledge of Thrombolytic Therapy Amongst Hospital Staff

Knowledge of Thrombolytic Therapy Amongst Hospital Staff

Quality of Care and Outcomes for In-Hospital Ischemic Stroke

The Impact of Early Specialist Management on Outcomes of Patients with In-Hospital Stroke

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