Abstract

In the U.S., diabetes is the 7th leading cause of death and 65% of these deaths are attributable to cardiovascular disease or stroke or to both. Among patients admitted for acute stroke, diabetes was associated with a higher risk of death, functional dependency and stroke recurrence. The purpose of this investigation was to examine the relationship between length of stay (LOS), type of stroke [ischemic stroke (IS), Transient Ischemic Attack (TIA), Subarachnoid Hemorrhage (SAH), Intracerebral Hemorrhage (ICH)] and the NIH Stroke Scale (NIHSS) in patients admitted to the hospital with an initial diagnosis of stroke or TIA and self-reported diabetes. There were N=5105 subjects (2448 males and 2657 females) in our center’s Get With The Guidelines-Stroke (GWTG-S) database from April 2014 to March 2019. Age, race, sex, insurance type, lipids and lipoproteins, initial serum glucose on admission, blood pressure, stroke type, and initial stroke severity (NIHSS) were the variables analyzed in a multiple regression analysis, with p <0.05 considered statistically significant. Mean LOS was 7.4 days (d) (range 0-119 d). LOS was negatively associated with age (as age (years) increased, the length of stay decreased by 0.05 d). We found that LOS to be positively associated with NIHSS score. Compared to those with mild NIHSS (0-5), those with severe NIHSS (>10) had LOS increased by 4.3 d, whereas moderate NIHSS (6-10) had LOS increased by 1.9 d. When compared with IS, we found that TIA was associated with a 2.6 d decrease in LOS whereas SAH and ICH were associated with a 6.7 and 3 d increase, respectively. Insurance type also was associated with LOS. Those on Medicaid had a 2.7 d increase in LOS compared to those who had Medicare. No statistically significant difference was found between Medicare and private insurance. There was no difference between ethnicities and LOS among our subjects. As expected, higher initial serum glucose level was positively associated with increased LOS. Specifically, for every 1 unit increase in initial serum glucose level was an associated 0.01 d increase in LOS. Thus, in the current study, we demonstrated that diabetes and initial serum glucose level continue to be important criteria in estimating the LOS in person admitted with a stroke. We recommend that these variables be considered for discharge planning and length of stay benchmarks in persons with history of diabetes.

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