Abstract
Identification of factors that determine length of stay (LOS) in total anterior circulatory stroke (TACS) has potential for targeted intervention to reduce the associated health care burden. This study aimed to determine which factors predict LOS following either ischaemic or haemorrhagic TACS. The study sample population was drawn from the Norfolk and Norwich Stroke and Transient Ischemic Attack (TIA) Register (1996–2012), a prospective registry. 2965 patients admitted with TACS verified by a stroke specialist team were included. Primary analysis identified predictors of length of stay (LOS) in either haemorrhagic or ischaemic TACS. Secondary analyses identified predictors of LOS in patients who were discharged alive or who died during admission separately. Moderate (p = 0.014) to severe disability (p = 0.015) and history of congestive heart failure (p = 0.027) in the primary analysis and pre-stroke residence in a care facility among patients who survived to discharge (p = 0.013) were associated with a shorter length of stay. Factors associated with increased length of stay included presence of neurological lateralisation in the primary analysis (p = 0.004) and amongst patients who died (p = 0.003 and p = 0.014 for ischaemic and haemorrhagic stroke, respectively). Patients with advanced age (≥85 years) with haemorrhagic stroke had longer LOS regardless of mortality outcome. Patients with low pre-morbid disability (modified Rankin score ≤2 who died following haemorrhagic TACS also had longer LOS. Our study found predictors of LOS following TACS include neurological lateralisation, pre-stroke disability status, congestive heart failure, pre-morbid residence and age. The identification of such factors would assist in resource allocation and discharge planning.
Highlights
Stroke is a leading cause of death and disability worldwide with an annual incidence of 152,000 per year in the UK [1] and 795,000 in the United States [2]
There were 232 (7.8%) aged less than 65 years, 1717 (57.9%) aged 65–84 years and 1016 (34.3%) aged 85 years or more. 2439 (82.2%) had an ischemic stroke. 526 (17.7%) had a haemorrhagic stroke. 2693 (90.8%) patients were admitted with clinical features consistent with lateralisation of neurological deficit. 456 (15.4%) patients were admitted from a care home. 1477 (58.7%) were fully independent prior to admission with baseline modified
In the ischemic stroke group, moderate and moderately severe or severe disability prior to Total anterior circulation stroke (TACS) were both significantly associated with shorter length of stay as compared with those who had no baseline disability
Summary
Stroke is a leading cause of death and disability worldwide with an annual incidence of 152,000 per year in the UK [1] and 795,000 in the United States [2]. Annual costs in the United States reach 33.6 billion dollars, of which 7.6 billion dollars are attributed directly to inpatient stays [2] representing a major economic burden to the health services. Length of stay (LOS) in acute medical care is a significant contributor to the financial implication of caring for stroke patients and the ability to accurately predict which patients are likely to require longer inpatient care would be desirable for both budgetary planning and healthcare provider considerations, and in communicating with patients and families to manage expectations at a vulnerable and uncertain time [4]. Deeper insight and better understanding of factors that determine LOS in TACS creates the potential for targeted intervention to reduce the associated health care burden
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