Readmission after stroke in a hospital-based registry

Lin, Hongbo; Chang, Wei‐Lun; Tseng, Mei‐Chiun

doi:10.1212/wnl.0b013e31820a0cd8

Cited by 81 publications

(86 citation statements)

References 17 publications

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“…3,18 In univariate and multivariate analyses without stratification, stroke severity, either initial severity measured by the NIHSS score or residual disability measured using the mRS, was not an independent factor associated with subsequent hospitalization either. Only 2 studies considered stroke severity in their multivariable analyses.…”

Section: Discussionmentioning

confidence: 91%

“…The mean time between the stroke and the subsequent hospitalization was 139±109 days, (median, 118; interquartile range, 40-229). The mean length of stay for this hospitalization was 10.6±15.5 days (median, 7; interquartile range, [3][4][5][6][7][8][9][10][11][12]. The most frequent reasons for hospitalization were neurological diseases (26.9%), cardiac and other vascular events (16.8%), orthopedic/rheumatologic reasons (13.8%), and infections (10.8%; Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Only 2 studies considered stroke severity in their multivariable analyses. 3,9 One did not find any significant association between the initial NIHSS score and 1-year readmission, 9 whereas the other concluded that dependency at discharge (mRS >2) but not the initial NIHSS score was associated with a greater risk of readmission at 1 year. 3 Several reasons could account for our negative results.…”

Section: Discussionmentioning

confidence: 95%

“…Our results are consistent with those from other studies on this topic, which suggested that between 31% and 49% of patients were readmitted within the year after the index stroke. [2][3][4][5][6][7][8][9] In addition, a cohort study showed that stroke patients had a 2-fold greater risk of readmission within 1 year compared with their matching nonstroke controls. 6 However, direct comparisons are made difficult by variations in case-mix between studies and the fact that previous works were limited by either the use of administrative databases with sometimes only scarce data on either the index stroke or the subsequent hospitalization, whereas other studies were hospital-based or considered readmissions to the same hospital only or both planned and unplanned hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

“…One major issue is that the risk of all-cause readmission to hospital after stroke is high, ranging between 31% and 49% at 1 year according to various studies. [2][3][4][5][6][7][8][9] Readmission to hospital has a deleterious effect on the well-being of patients and leads to an increase in socioeconomic costs. 8,10 The better identification of patients at risk could therefore be useful so as to develop preventive strategies to reduce the number of emergency hospitalizations after stroke.…”

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confidence: 99%

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Hospitalization Within the First Year After Stroke

Lainay

Benzenine

Durier

et al. 2015

Stroke

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All patients with a first-ever stroke that occurred between January 1, 2009, and December 31, 2011, were prospectively identified among residents of the city of Dijon, France (151 543 inhabitants), from the Dijon Stroke Registry, a population-based study that was established in 1985.11 This registry complies with the defined criteria for conducting stroke incidence studies, 12,13 and its methodology has been extensively described elsewhere.11 Hence, to attempt to achieve complete case-ascertainment, hot and cold pursuit procedures based on multiple overlapping sources of information were used to identify fatal Background and Purpose-This population-based study aimed to identify unplanned hospitalization within the first year after stroke to determine factors associated with it and consequences on survival. Methods-All first-ever acute strokes occurring in Dijon, France, from 2009 to 2011, were prospectively collected from a population-based registry. Demographics and clinical data, including stroke severity measured by the National Institutes of Health Stroke Scale and disability after stroke, were recorded. For each patient, the first unplanned hospitalization that occurred within 1 year after stroke was retrieved by linking data with the national French Hospital Discharge Database. Predictors of hospitalization and survival at 1 year were identified using logistic regression models. Results-Among the 613 patients recorded, 94 (15.3%) were excluded because of early death. Of the 519 remaining patients, 167 (32.2%) were hospitalized at 1 year. Subsequent hospitalization led to in-hospital death for 16 (9.6%) patients. In multivariable analyses, only a history of hypertension and atrial fibrillation were associated with hospitalization. In stratified analyses, the National Institutes of Health Stroke Scale score was associated with a higher risk of hospitalization (odds ratio, 1.13; 95% confidence interval, 1.03-1.22; P=0.006), whereas only a trend was noted for disability (odds ratio, 2.26; 95% confidence interval, 0.82-6.22; P=0.113) in patients who returned home after the index stroke. Hospitalization was negatively associated with being alive at 1 year (odds ratio, 0.36; 95% confidence interval, 0.19-0.66; P<0.01). Conclusions-Stroke survivors are at high risk of hospitalization after the episode, and subsequent admission is associated with poor survival, thus highlighting the need for follow-up interventions after discharge to prevent readmission.

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Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Hospitalization Within the First Year After Stroke

Lainay

Benzenine

Durier

et al. 2015

Stroke

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Indwelling urinary catheterization after acute stroke

Tseng

Chen

et al. 2012

Neurourology and Urodynamics

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Predictors of hospital readmission 1 year after ischemic stroke

Leitão

Brito²,

Pinho

et al. 2016

Intern Emerg Med

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Predictors of short-term readmission after ischemic stroke have been previously identified, but few studies analyzed predictors of long-term readmission, namely early imaging findings and treatment with intravenous thrombolysis (IVT). To characterize predictors of hospital readmission during the first year after hospitalization for ischemic stroke. The study consists of a retrospective cohort of consecutive ischemic stroke patients admitted in a Portuguese university hospital during 2013, who survived index hospitalization. We collected clinical and imaging information using the electronical clinical record. Information concerning 1-year unplanned hospital readmissions was assessed using the Portuguese electronic Health Data Platform. Descriptive and univariate analyses, Kaplan-Meier survival curve and multivariate survival analysis with Cox regression model were used. We included 480 patients, 50.6 % women, median age 79 years (interquartile range = 68-85). One-year hospital readmissions occurred in 165 patients [34.4 %, 95 % confidence interval (95 % CI) 30.2-38.7]. The main causes for readmission were infectious diseases (43.8 %), ischemic stroke or transient ischemic attack recurrence (13.2 %) and cardiac diseases (6.4 %). In-hospital mortality associated with readmission was 23.0 %. The independent predictors of 1-year hospital readmission after ischemic stroke were admission mini-National Institute of Health Stoke Scale [hazards ratio (HR) 1.05, 95 % CI 1.02-1.08, p = 0.002], and mild or absent early signs of ischemia on admission computed tomography (CT) (HR 0.54, 95 % CI 0.32-0.91, p = 0.021) and IVT (HR 0.11, 95 % CI 0.01-0.80, p = 0.029). Hospital readmission during the first year after ischemic stroke occurs in 1/3 of patients and is associated with high in-hospital mortality. Clinical stroke severity, early signs of ischemia on admission CT, and treatment with IVT are independent predictors of 1-year hospital readmission.

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Readmission after stroke in a hospital-based registry

Abstract: Stroke survivors have high likelihood of readmission within 1 year following discharge, with infections and recurrent vascular events being the most common reasons. Identification of high-risk subgroups might foster preventive interventions.

Cited by 81 publications

References 17 publications

Hospitalization Within the First Year After Stroke

Hospitalization Within the First Year After Stroke

Indwelling urinary catheterization after acute stroke

Predictors of hospital readmission 1 year after ischemic stroke

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