Abstract

National and regional systems of stroke care are designed to provide patients with widespread access to hospitals with thrombolytic capabilities. However, such triaging systems may contribute to fragmentation of care. This study aims to compare rates of readmission and outcomes between index and non-index hospitals for stroke patients following intravenous thrombolytic therapy (IVT). This study utilized a nationally representative sample of stroke patients with IVT from the Nationwide Readmissions Database from 2010 to 2014. Descriptive and regression analyses were performed for patient and hospital level factors that influenced 90-day readmissions and regression models were used to identify differences in mortality, complications, and repeat readmissions between patients readmitted to index (facility where IVT was administered) and non-index hospitals. In the study, 49415 stroke patients were treated with IVT, of whom 21.7% were readmitted within 90 days. Among readmissions, 79.4% of patients were readmitted to index hospitals and 20.6% to non-index hospitals. On multivariate logistic regression analysis, index hospital readmission was independently associated with lower frequency of second readmissions (non-index OR 1.09, 95%CI 1.07-1.11, p<0.0001) but not with increased mortality or major complications (p=ns). Approximately one-fifth of stroke patients treated with thrombolysis were readmitted within 90 days, one-fifth of whom were readmitted to non-index hospitals. Although readmission to index hospital was associated with lower frequency of subsequent readmissions, readmission to non-index hospital was not associated with increased mortality or major complications. This difference may be due to standardized algorithms, mature systems of care, and demanding metrics required of stroke centers.

Highlights

  • An estimated 795,000 people suffer from stroke in the United States each year [1]

  • Descriptive and regression analyses were performed for patient and hospital level factors that influenced 90-day readmissions and regression models were used to identify differences in mortality, complications, and repeat readmissions between patients readmitted to index and non-index hospitals

  • This difference may be due to standardized algorithms, mature systems of care, and demanding metrics required of stroke centers

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Summary

Introduction

An estimated 795,000 people suffer from stroke in the United States each year [1]. Eighty-seven percent of these strokes are ischemic. Pre-hospital neurological deterioration occurs in 9% of ischemic stroke patients [2]. Approved in 1996 for use in the United States after the positive National Institute of Neurological Disorders and Stroke (NINDS) trial [4], thrombolysis with intravenous tissue plasminogen activator (IV-tPA) is considered to be the standard of care for eligible patients suffering from acute ischemic stroke [4]. The recommended window for IV-tPA treatment is within 3, or in some cases 4.5, hours after the onset of stoke [5, 6]. It is, critical for ischemic stroke patients to be brought to a capable stroke center in rapid fashion following onset of symptoms

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