Outcomes for patients with in-hospital stroke: A multicenter study from the Australian stroke clinical registry (AuSCR)

Journal article


Cadihac, Dominique, Kilkenny, Monique, Lannin, Natasha, Dewey, Helen M., Levi, Chris, Hill, Kelvin, Grabsch, Brenda, Grimley, Rohan, Blacker, David, Thrift, Amanda, Middleton, Sandy, Anderson, Craig and Donnan, Geoffrey. (2019) Outcomes for patients with in-hospital stroke: A multicenter study from the Australian stroke clinical registry (AuSCR). Journal of Stroke and Cerebrovascular Diseases. 28(5), pp. 1302 - 1310. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.026
AuthorsCadihac, Dominique, Kilkenny, Monique, Lannin, Natasha, Dewey, Helen M., Levi, Chris, Hill, Kelvin, Grabsch, Brenda, Grimley, Rohan, Blacker, David, Thrift, Amanda, Middleton, Sandy, Anderson, Craig and Donnan, Geoffrey
Abstract

Background The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. Aims To explore differences in long-term outcomes among patients with in-hospital events treated in stroke units (SUs) compared to those managed in other hospital wards. Methods Forty-five hospitals participating in the Australian Stroke Clinical Registry between January 2010 and December 2014 contributed data. Survival of all patients with in-hospital stroke to 180 days after stroke and health-related quality of life, using EQ-5D-3L among 73% eligible, were compared using multilevel, multivariable regression models. Models were adjusted for age, sex, index of relative socioeconomic disadvantage, ability to walk, stroke type, transfer from another hospital, and history of stroke. Results Among 20,786 stroke events, 1182 (5.1%) occurred in-hospital (median age 77 years, 49% male). Patients with in-hospital stroke treated in SUs died less often within 30 days (Hazard Ratio 0.56; 95% CI 0.39-0.81) than those not admitted to SUs. Survivors reported similar health-related quality of life between 90 and 180 days compared to those treated in other wards (coefficient = 0.01, 95% CI –0.06-0.09, P = .78). Patients managed in SUs more often received recommended management (e.g. swallowing screening). Conclusion The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.

KeywordsStroke; stroke unit; stroke management; hospitals; outcome
Year2019
JournalJournal of Stroke and Cerebrovascular Diseases
Journal citation28 (5), pp. 1302 - 1310
PublisherElsevier
ISSN1052-3057
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.026
Scopus EID2-s2.0-85062034111
Open accessPublished as green open access
Page range1302 - 1310
Research GroupNursing Research Institute
Author's accepted manuscript
License
Publisher's version
Place of publicationUnited Kingdom
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