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Outcomes for patients with in-hospital stroke : A multicenter study from the Australian stroke clinical registry (AuSCR)
Cadihac, Dominique A. Kilkenny, Monique F. Lannin, Natasha A. Dewey, Helen M. Levi, Christopher R. Hill, Kelvin Grabsch, Brenda Grimley, Rohan Blacker, David Thrift, Amanda G.
Cadihac, Dominique A.
Kilkenny, Monique F.
Lannin, Natasha A.
Dewey, Helen M.
Levi, Christopher R.
Hill, Kelvin
Grabsch, Brenda
Grimley, Rohan
Blacker, David
Thrift, Amanda G.
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.
Keywords
stroke, stroke unit, stroke management, hospitals, outcome
Date
2019
Type
Journal article
Journal
Journal of Stroke and Cerebrovascular Diseases
Book
Volume
28
Issue
5
Page Range
1302-1310
Article Number
ACU Department
Nursing Research Institute
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Published as green open access
License
File Access
Open
Controlled
Controlled