214 A single-site retrospective review of In-Hospital Stroke

Abstract

Abstract Background In-Hospital Stroke (IHS) is defined as a stroke occurring while in hospital for another diagnosis. IHS represent a distinct cohort with greater deficits, higher mortality rates, and are less likely to be discharged home compared to Community-Onset Stroke (COS). Methods A retrospective cohort study was performed in an acute teaching hospital from January 1st 2020 to December 31st 2021 to compare quality of care and outcome measures of IHS cases with COS counterparts. Stroke cases were identified from the hospital database submitted to the Irish National Audit of Stroke (INAS) during the 2-year period. Descriptive statistics were calculated. Categorical variables were compared using Chi Square. Results Of the 563 stroke cases during the 2-year period, 15% (n = 88) reflected an IHS event. The median age observed in IHS and COS cohorts was 73 and 72 years respectively. COS patients were more likely to have no disability pre-stroke when compared with IHS patients (47% versus 30%, p = 0.006). Over half (52%; n = 46) of IHS patients were admitted to the intensive care unit (ICU) during their hospital admission (p = <.0001).Co-diagnosis with COVID-19 was more common among IHS than COS (9% versus 1%; p = 0.0003). The proportion of patients receiving thrombolysis was greater in the COS cohort compared to IHS cohort (12% versus 7%; p = 0.06). Fifteen percent (n = 13) of IHS cases died compared with 12% (n = 56) of COS. IHS cases were more likely to be discharged to long term care (LTC) (8% versus 3%; p = 0.04), have moderate/severe disability (38% versus 24%; p = 0.001) and have longer length of stay (LOS) (43% versus 4%; p < 0.0001) when compared with COS counterparts. COS cases were more likely than IHS cases to be admitted to the stroke unit (SU) (79% versus 43%; p < 0.0001). Swallow screening was performed more frequently on the COS cohort (76% versus 50%; p < 0.0001). Conclusion IHS represent a distinct stroke subgroup in terms of outcomes and performance on stroke quality of care measures.