Abstract WMP42: Trends of In-Hospital Strokes Over Time: Results From the Greater Cincinnati and Northern Kentucky Stroke Study

Abstract

Background: Prior studies have shown that individuals who have an in-hospital stroke are less likely to receive thrombolysis. Few studies have investigated the trends of in-hospital strokes over time, and many large databases do not include in-hospital strokes. We aimed to determine how in-hospital strokes compared to out-of-hospital stroke over time in terms of number of strokes, treatment, and 30-day mortality. Methods: Within the Greater Cincinnati Northern Kentucky area, all incident strokes among adult residents were ascertained at all hospitals during July 1993-June 94, calendar years 1999, 2005, 2010, 2015. Data for all potential cases were adjudicated by study physicians. We defined in-hospital strokes as all physician adjudicated strokes that happened when the patient had already been admitted for a condition aside from stroke. Out of hospital strokes were patients who were not admitted to the hospital when their stroke symptoms. We used national death index data to determine death at 30 days post-discharge. Results: Among 13134 strokes from 1993-2015, 1152 (9%) occurred in the hospital. The percentage of in-hospital strokes over time stayed similar (Figure 1). Overall, in-hospital strokes were more likely to be hemorrhagic in 2015 than in 1993/94; 12 % in 2015 vs. 3.6% in1993/94 (p=0.003). For both in-hospital and out-of-hospital strokes the percentage of ischemic strokes given thrombolysis increased over time (2% vs. 3% in 1993 compared to 12% vs. 10% in 2015 for in-hospital and out-of-hospital strokes respectively). 30-day mortality rate was higher for in-hospital strokes compared to out of hospital strokes throughout all study years (30.1% for in-hospital strokes and 13.4% for out of hospital strokes; p<0.001). Conclusions: We found in this population-based study that although the rate of thrombolysis is increasing for in-hospital strokes; 30-day mortality outcomes are still much worse.