Abstract 2968: Outcomes Of Young Acute Ischemic Stroke Over The Last Decade: Insights From Nationwide Inpatient Sample

Abstract

Background: The burden of young ischemic stroke has increased over the years. However, outcomes of young patients with acute ischemic stroke (AIS) remain unknown. Over the last decade, with increasing utilization rate of iv tpa, our objective was to evaluate trends in survival and discharge outcomes of young AIS patients in the United States. Methods: Data from the Nationwide Inpatient Sample for the years 2001 through 2009 were reviewed. Hospitalizations with a discharge diagnosis of an acute ischemic stroke (ICD-9 codes: 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 424.01, 434.11, 434.91 and 436) were included. Nationwide estimates of deaths and discharge destination were calculated for each year within the young AIS subset. The Cochrane Armitage test was used to assess trend across the years Results: From 2001 through 2009, there were an estimated 4,917,217 admissions for acute ischemic stroke. Out of that, 204,703 (4.16%) were young patients with AIS. Thrombolysis in young ischemic stroke increased from 354 (1.84% of young AIS) in 2001 to 1237 (4.97%) in 2009 (p<0.0001). There was a progressive decrease in mortality in young AIS patients, from 6.81% in 2001 to 5.43% in 2009 (trend p= 0.027). Discharge to home or home with home health did not show any significant change (trend p= 0.52). Discharge to rehabilitation facilities showed significant increase over the years, 3.42% in 2002 to 12.7% in 2009 (trend p <0.0001). Discharge to other facilities other than rehabilitation showed significant decrease over the years, 29.1% in 2001 to 17.8% in 2009 (trend p<0.0001). Rate of intracranial hemorrhage, 2.70% in 2001 to 2.69% in 2009, did not show any significant change despite increasing use of iv tpa (trend p=0.39). Conclusion: Over the last decade, deaths from AIS among young patients have decreased. The increase in rehabilitation placement and decrease in nursing home discharges suggest improving neurologic outcomes. Modern treatments such as stroke units, thrombolysis, and mechanical thrombectomy may be responsible for the reductions in mortality and morbidity.