Patterns and Outcomes of Intensive Care on Acute Ischemic Stroke Patients in the US

Abstract

BACKGROUND: Up to 20% of acute ischemic stroke (AIS) patients may benefit from intensive care unit (ICU)-level care; however, there are few studies evaluating ICU availability for AIS. We aim to summarize the proportion of elderly AIS patients in the United States who are admitted to an ICU and assess the national availability of ICU-level care in AIS. METHODS: We performed a retrospective cohort study using de-identified Medicare inpatient datasets from January 1, 2016 through December 31, 2019 for US individuals aged ≥65 years. We used validated International Classification of Diseases, Tenth Revision , Clinical Modification codes to identify AIS admission and interventions. ICU-level care was identified by revenue center code. AIS patient characteristics and interventions were stratified by receipt of ICU-level care, comparing differences through calculated standardized mean difference score due to large sample sizes. RESULTS: From 2016 through 2019, a total of 952 400 admissions by 850 055 individuals met criteria for hospital admission for AIS with 19.9% involving ICU-level care. Individuals were predominantly >75 years of age (58.5%) and identified as white (80.0%). Hospitals on average admitted 11.4% (SD 14.6) of AIS patients to the ICU, with the median hospital admitting 7.7% of AIS patients to the ICU. The ICU admissions were younger and more likely to receive reperfusion therapy but had more comorbid conditions and neurologic complications. Of the 5084 hospitals included, 1971 (38.8%) reported no ICU-level AIS care. Teaching hospitals (36.9% versus 1.6%, P <0.0001) with larger AIS volume ( P <0.0001) or in larger metropolitan areas ( P <0.0001) were more likely to have an ICU available. CONCLUSIONS: We found evidence of national variation in the availability of ICU-level care for AIS admissions. Since ICUs may provide comprehensive care for the most severe AIS patients, continued effort is needed to examine ICU accessibility and utility among AIS.

Stretcher Angles: Impact on Vital Signs and Optic Nerve Sheath Diameter in Prehospital Stroke Patients

“…While 73.2% of the patients were hospitalized in the ICU, 26.8% were hospitalized in the neurology inpatient service and continued to be followed up. There are similar results for ICU and inpatient service hospitalizations in stroke studies (23,24).…”

Racial disparities in access to, and outcomes of, acute ischaemic stroke treatments in the USA

“…We acknowledge the relationship between the methodology and purpose of this paper and three of our prior papers. [13][14][15] Patient and public involvement Patients were not involved in the planning or execution of this study.…”

Assessing the predictive value of neutrophil percentage to albumin ratio for ICU admission in ischemic stroke patients

“…Acute ischemic stroke (AIS) remains a substantial global health challenge, contributing to increased morbidity ( 1 , 2 ), disability ( 3 ), and mortality ( 4 , 5 ). While many cases of AIS can be efficiently treated in regular hospital environments or specialized stroke units, it is worth noting that approximately quarter of AIS patients require admission to an intensive care unit (ICU) ( 3 , 6 ). These ICU admissions are crucial due to the severity of the condition.…”

“…These ICU admissions are crucial due to the severity of the condition. Importantly, the reported mortality rates for stroke patients receiving treatment in the ICU exhibit a wide range, varying from 14% to as high as 70% (1,(3)(4)(5), underscoring the need for comprehensive and targeted care strategies for this patient population.…”