Specialised stroke care missed when strokes occur in hospital


By Mardi Chapman

6 Jun 2019

Patients who have a stroke while in hospital probably benefit from a move to the stroke unit once their reason for admission has been stabilised.

There, they are more likely to have better access to evidence-based care, which can “significantly reduce death and disability”.

An observational study using data from the Australian Stroke Clinical Registry (AuSCR) between 2010 and 2014 found about 5% of all registered strokes occurred while patients were in hospital.

The data included all episodes of ischaemic, intracerebral hemorrhage (ICH) and undetermined stroke but not transient ischemic attacks.

It found patients who have an in-hospital stroke were less likely to be admitted to a dedicated stroke unit (SU) than patients who had their stroke before hospital admission (63% v 81%).

Deaths were more common in patients with an in-hospital stroke than a stroke that occurred outside the hospital. There were also fewer deaths within 180-days for patients with in-hospital events treated in an SU than those treated in another ward.

“In multivariable analyses, treatment in an SU was associated with a reduced hazard of death at 7 and 30 days after admission when compared to patients not treated in an SU,” the study said.

“Patients with an in-hospital event who were treated in an SU more often received a range of processes of care (e.g. mobilized during admission: 79% SU, 52% other wards and intravenous thrombolysis: 14% SU, 6% other wards) and were more often discharged to rehabilitation compared to those not treated in an SU.”

“In a small subanalysis, patients with in-hospital events were more likely to report being independent (mRS 0-2) at 3-6 months follow-up when treated in an SU (21/39; 54%) than those not treated in an SU (1/8; 13%; P = .03).”

The study found stroke unit care was associated with increased survival for stroke patients irrespective of whether the onset was in hospital or in the community.

“In the current study, patients managed in an SU were more likely to receive acute care interventions such as thrombolysis and aspirin, and were more often mobilized, received swallow screening, and prescribed prevention medications at discharge. These interventions are most often associated with better outcomes.”

The researchers said it was plausible that some patients could not justifiably be transferred into the SU as other acute conditions may take priority over stroke management.

“However, the benefits of stroke unit care appear to be independent of the co-morbidity profile of patients, and in these circumstances the involvement of the stroke team is still required,” they said.

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