Incidence of stroke among inpatients in a large Italian hospital.

Azzimondi, G; Nonino, Francesco; Fiorani, L; Vignatelli, Luca; Stracciari, Andrea; Pazzaglia, P; D’Alessandro, Roberto

doi:10.1161/01.str.25.9.1752

Cited by 25 publications

(24 citation statements)

References 11 publications

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“…Our study involved the prospective identification of a relatively large number of IHS cases from a broadly representative population of statewide hospitals, and therefore differs from several of the previous reports that were based on a limited number of cases and/or hospitals [2, 3, 25]. This study confirmed previous findings that cardiovascular, neurological, and neurosurgical disorders were the most common admitting diagnoses among patients who went on to develop IHS.…”

Section: Discussionsupporting

confidence: 82%

In-Hospital Stroke in a Statewide Stroke Registry

Farooq¹,

Reeves²,

Gargano³

et al. 2007

Cerebrovasc Dis

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Background:In-hospital stroke (IHS) represents 5–15% of all hospitalized acute stroke cases, and is associated with poor outcomes. IHS represents an important area for prevention since many cases occur in high-risk patients undergoing cardiovascular procedures. Our objectives were to compare the quality of care, treatments, and outcomes of IHS with out-of-hospital stroke (OHS) cases. Methods: A 6-month prospective cohort of IHS and OHS stroke cases from a statewide acute stroke registry of 15 representative hospitals was assembled. Data were abstracted on demographic, clinical characteristics, in-hospital care (including tPA treatment), discharge instructions, and in-hospital outcomes (mortality and modified Rankin Scale [mRS] at discharge). Results:177 (6.5%) of the 2,743 cases in the registry were IHS cases. 40% of IHS cases were admitted with a cardiovascular or neurologically related problem, and 68% underwent an invasive diagnostic or surgical procedure prior to their stroke. IHS cases were less likely to have the cerebral vasculature examined or to have a lipid panel drawn. Compared to OHS, IHS had higher case fatality (14.6 vs. 6.9%; p = 0.04), greater functional impairment (mRS ≧4) (61 vs. 36%; p < 0.001), and were less likely to be discharged home (23 vs. 52%, p < 0.01). Conclusions:In this prospective registry, 1 in 15 acute stroke cases occurred in the hospital, and almost 70% had an invasive procedure undertaken prior to their stroke event. In-hospital cases received similar quality of care as OHS cases, but had significantly worse outcomes.

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Section: Discussionsupporting

confidence: 82%

In-Hospital Stroke in a Statewide Stroke Registry

Farooq¹,

Reeves²,

Gargano³

et al. 2007

Cerebrovasc Dis

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“…Therefore, approximately 1 of 25 stroke patients had an in-hospital stroke onset. Azzimondi et al [1] reported that the stroke incidence rate among hospitalized patients was 11.08/1,000 per year, which was higher than that reported in community-based studies. In the present study, since we did not determine the number of in-hospital patients for each participating hospital, we could not calculate the incidence rate of in-hospital stroke.…”

Section: Discussionmentioning

confidence: 93%

“…The mechanism of in-hospital stroke has been reported to be due to iatrogenic causes, such as operative procedures, unsuccessful cardioversion, coronary angiography and to be associated with coronary artery diseases [1, 2]. However, the characteristics of in-hospital stroke have not been clearly elucidated.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of In-Hospital Onset Ischemic Stroke

Kimura

Minematsu²,

Yamaguchi³

2006

Eur Neurol

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Background and Purpose: The aim of the present study was to clarify the clinical characteristics of in-hospital onset stroke. Material and Methods: We analyzed 15,815 patients with acute brain infarction registered in the Japan Multicenter Stroke Investigators’ Collaboration (J-MUSIC) registry. Results: The in-hospital onset group included 694 (4.4%) patients and the out-of-hospital group included 15,121 (95.6%) patients. Atrial fibrillation (AF) was more common in the in-hospital onset group (34.6%) than in the out-of-hospital group (20.4%, p < 0.001). The admission NIHSS score (median, in-hospital 13 vs. out-of-hospital 5, p < 0.0001) and the mortality rate at discharge were higher in the in-hospital group than in the out-of-hospital group (in-hospital 19.2% vs. out-of-hospital 6.8%, p < 0.0001). On multivariate logistic regression analyses, female gender (OR 1.1, 95% CI 1.1–1.3), older age (OR 1.0, 95% CI 1.02–1.03), AF (OR 4.4, 95% CI 4.0–4.8), history of stroke (OR 1.3, 95% CI 1.2–1.4) and in-hospital stroke onset (OR 3.3, 95 %CI 2.7–3.9) were independent factors associated with severe stroke (NIHSS score ≧11), and older age (OR 1.03, 95% CI 1.02–1.04), the presence of AF (OR 1.21, 95% CI 1.0–1.5), in-hospital stroke onset (OR 1.01, 95% CI 1.01–1.02) and NIHSS score at initial evaluation (OR 1.15, 95% CI 1.14–1.17) were independent factors associated with death at discharge. Conclusion: In-hospital stroke onset was not uncommon. The neurological deficits in patients with in-hospital onset stroke were severer and the outcome was worse than in those with out-of-hospital stroke. Therefore, a strategy to reduce in-hospital stroke onset should be implemented.

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“…The crude incidence of stroke in hospitalized patients has been estimated at 11/1,000 [5] , compared to an incidence of 2/1,000 of stroke in the general population [6] . Ischemic stroke occurs in 0.1-0.3% of patients with myocardial infarction [7] and among patients with myocardial infarction, cardiac failure and atrial fibrillation have been identified as the most common predictors for ischemic stroke [8] .…”

Section: Introductionmentioning

confidence: 99%

Inpatient and Community Ischemic Strokes in a University Hospital

Dulli

Samaniego²

2007

Neuroepidemiology

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Background: Previous studies have shown that inpatient strokes are common and severe. We sought to characterize the risk factors, stroke subtypes, timing of acute stroke evaluation and frequency of thrombolytic therapy in inpatient ischemic strokes compared with community ischemic strokes. Design/Methods: The hospital records of patients admitted for acute ischemic stroke between 1996 and 2002 were reviewed. Acute stroke was defined as occurrence of stroke symptoms within 72 h, and in-hospital status was assigned if the patient was currently admitted for another illness at the time of the stroke. Patient demographics such as medical versus surgical service, admission diagnoses, clinical features including stroke risk factors, access to thrombolytic therapy and immediate outcome were analyzed. Results: Of 947 patients with acute ischemic stroke, 161 (17.0%) had strokes occurring while already in the hospital (IHIS), compared to 786 (83%) that occurred in the outpatient community (CIS). Approximately two thirds of IHIS occurred on medical services (102, 63.4%) and one third on surgical services (59, 36.7%). Mean age, male gender, atherothrombotic etiology and risk factors including hypertension, diabetes and smoking history were of similar frequencies in IHIS and CIS, but penetrating artery disease was the cause of only 5.6% of IHIS compared to 21.8% of CIS (p < 0.0001). The mean modified Rankin scale for IHIS at presentation was 4.33 ± 0.74, compared to 3.67 ± 1.03 for CIS (p < 0.0001). Of 161 IHIS patients, 21 (13.0%) had neurological assessment within 3 h of symptom onset, compared to 16.0% of CIS patients (p = 0.403, n.s.), and the rate of thrombolytic therapy was not significant between IHIS (3.7%) and CIS (5.6%) patients. Conclusions: IHIS are common and severer than CIS. The use of thrombolytic therapy in IHIS patients was limited because of time of recognition and inpatient-associated conditions. Increased vigilance for timely neurological assessment of these patients is warranted.

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Incidence of stroke among inpatients in a large Italian hospital.

Cited by 25 publications

References 11 publications

In-Hospital Stroke in a Statewide Stroke Registry

In-Hospital Stroke in a Statewide Stroke Registry

Characteristics of In-Hospital Onset Ischemic Stroke

Inpatient and Community Ischemic Strokes in a University Hospital

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