Retrospective case note review of acute and inpatient stroke outcomes

Aly, Nabil

doi:10.1136/bmj.320.7248.1511

Cited by 27 publications

(38 citation statements)

References 3 publications

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“…The high mortality and greater neurologic severity in IHS patients has previously been addressed [3,4,23]. The poor prognosis of IHS patients might be ascribed to the severity of co-morbid diseases and the high frequency of cardioembolic infarctions.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the characteristics for in‐hospital and out‐of‐hospital ischaemic strokes

Park

Cho

Kim

et al. 2009

Euro J of Neurology

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Background and purpose: Patients who are being admitted to a hospital due to diseases other than stroke may develop a stroke (in-hospital stroke; IHS). Methods: We enrolled 111 consecutive patients who developed IHS outside a neurology ward during a 5-year period at a single hospital. The frequency, characteristics, and outcomes for IHS patients were compared with patients who develop ischaemic stroke outside of the hospital (out-of-hospital stroke; OHS). Results: Forty-six percent of IHS occurred in the department of cardiology or cardiovascular surgery and 60% were associated with surgery or procedures. In comparison with the OHS patient group, the IHS patient group showed an increased frequency of cardiac disease, leukocytosis, and anemia. Cardioembolism, stroke of other determined etiologies, and an incomplete evaluation were more common in the IHS group, whereas large artery atherosclerosis was more frequent in the OHS group. The IHS group had up to a 10-fold higher mortality than the OHS group, with sepsis being the most common cause of death in the IHS group. Conclusions: IHS has distinct etiologies and stroke mechanisms from OHS. The prevention and management of infection could decrease mortality in IHS patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of the characteristics for in‐hospital and out‐of‐hospital ischaemic strokes

Park

Cho

Kim

et al. 2009

Euro J of Neurology

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“…Several prior studies on this topic are based on a small numbers of stroke cases, are limited to a small number of hospitals, or tend to focus on one particular aspect such as time of evaluation [3], stroke mechanism [2], risk factors [18], or outcomes [14]. In this study we describe a large case series of IHS cases that were identified as part of a representative statewide prospective hospital-based acute stroke registry.…”

Section: Introductionmentioning

confidence: 99%

“…The case fatality rate of IHS cases is between 2- and 3-fold higher than OHS [1, 14]. The increased severity of IHS also translates to longer hospital stays, and a greater need for rehabilitation services post-discharge [3, 14]. …”

Section: Introductionmentioning

confidence: 99%

“…Compared to out-of-hospital stroke (OHS), cases of IHS are more likely to have an ischemic mechanism and are more likely to be embolic in origin [2, 12]. The spectrum of risk factors also differs for IHS cases; factors such as cerebrovascular stenosis [12, 13], atrial fibrillation [14,15,16], remote as well as recent myocardial infarction [14, 17], and elevated or unstable blood pressure [18], have all been reported to occur more frequently in cases with IHS.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Previous studies suggest that in-hospital strokes are more severe and have worse outcomes than strokes occurring in the community. 1,5,6,8,9 However, there are few previous studies of in-hospital stroke quality of care and none at the national level. 6,[10][11] The purpose of this study was to analyze quality of care and clinical outcomes for in-hospital acute ischemic strokes using the national Get With The Guidelines-Stroke (GWTG-Stroke) registry of the American Heart Association (AHA)/American Stroke Association (ASA).…”

mentioning

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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Retrospective case note review of acute and inpatient stroke outcomes

Cited by 27 publications

References 3 publications

Comparison of the characteristics for in‐hospital and out‐of‐hospital ischaemic strokes

Comparison of the characteristics for in‐hospital and out‐of‐hospital ischaemic strokes

In-Hospital Stroke in a Statewide Stroke Registry

Quality of Care and Outcomes for In-Hospital Ischemic Stroke

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