Stroke Systems Of Care Research Articles

Impact of State Stroke Systems of Care Laws on Stroke Outcomes.

Since 2003, 38 US states and Washington, DC have adopted legislation and/or regulations to strengthen stroke systems of care (SSOCs). This study estimated the impact of SSOC laws on stroke outcomes. We used a coded legal dataset of 50 states and DC SSOC laws (years 2003-2018), national stroke accreditation information (years 1997-2018), data from the Healthcare Cost and Utilization Project (years 2012-2018), and National Vital Statistics System (years 1979-2019). We applied a natural experimental design paired with longitudinal modeling to estimate the impact of having one or more SSOC policies in effect on outcomes. On average, states with one or more SSOC policies in effect achieved better access to primary stroke centers (PSCs) than expected without SSOC policies (ranging from 2.7 to 8.0 percentage points (PP) higher), lower inpatient hospital costs (USD 610-1724 less per hospital stay), lower age-adjusted stroke mortality (1.0-1.6 fewer annual deaths per 100,000), a higher proportion of stroke patients with brain imaging results within 45 min of emergency department arrival (3.6-5.0 PP higher), and, in some states, lower in-hospital stroke mortality (5 fewer deaths per 1000). Findings were mixed for some outcomes and there was limited evidence of model fit for others. No effect was observed in racial and/or rural disparities in stroke mortality.

Stroke systems of care in South-East Asia Region (SEAR): commonalities and diversities.

The Southeast Asia Region (SEAR) accounts for nearly 50% of the developing world's stroke burden. With various commonalities across its countries concerning health services, user awareness, and healthcare-seeking behavior, SEAR still presents profound diversities in stroke-related services across the continuum of care. This review highlights the numerous systems and challenges in access to stroke care, acute stroke care services, and health care systems, including rehabilitation. The paper has also attempted to compile information on the availability of stroke specialized centers, Intravenous thrombolysis (IVT) ready centers, Endovascular therapy (EVT) ready centers, rehabilitation centers, and workforce against a backdrop of each country's population. Lastly, the efforts of WHO (SEARO)-CMCL (World Health Organization-South East Asia region, Christian Medical College & Hospital Ludhiana) collaboration towards improving stroke services and capacity among the SEAR have been described.

Stroke Systems of Care:: A Systematic Approach to Saving Neurons.

Stroke continues to be a major public health concern, accounting for more than 800,000 strokes per year and remains the leading cause of disability. Stroke systems of care are comprehensive frameworks designed to ensure efficient and effective management of stroke patients. This article provides a brief overview of the coordinated network of healthcare providers, emergency medical services, and hospitals working together to deliver timely and specialized care including pre-hospital care, acute hospital care, rehabilitation, and community reintegration.

Simulation modelling to study the impact of adding comprehensive stroke centres. Can we deliver endovascular thrombectomy sooner?

ObjectivesRegional accessibility and distribution of endovascular thrombectomy (EVT) capable facilities, that is, comprehensive stroke centres (CSCs), may significantly influence time to treatment. We analysed the impact of adding CSCs in...

Risk factors for in-hospital complications in patients with acute ischemic stroke: Retrospective cohort in a national reference hospital in Peru

ObjectiveTo describe the clinical and demographic characteristics of patients with acute cerebral infarction treated at a national reference hospital in Peru and determine the risk factors for in-hospital complications. MethodsWe conducted a retrospective cohort study including 192 patients with acute ischemic stroke in a national reference hospital in Peru from January to September 2021. Clinical, demographic and paraclinical information was recorded from medical records. We estimated risk ratios and 95% confidence intervals using regression models with Poisson family and robust variance for the bivariate and multivariate model, adjusting for age, sex and risk factors for stroke. ResultsAt least one in-hospital complication occurred in 32.3% of the patients. The most frequent complications were infectious in 22.4%, followed by 17.7% of neurological complications, with other complications, such as thromboembolism, immobility and miscellaneous, being much less frequent. Regression analysis showed that stroke severity (RR = 1.76; 95%CI:1.09–2.86) and albumin greater than 3.5 mg/dL (RR = 0.53; 95%CI: 0.36–0.79) were independent risk factors for the presence of in-hospital complications. ConclusionsA high rate of in-hospital complications were observed, among which infectious and neurological complications were the most frequent. Stroke severity was a risk factor and albumin greater than 3.5 mg/dL was a protective factor for the incidence of in-hospital complications. These results can serve as a starting point for establishing stroke care systems that consider differentiated flows for the prevention of in-hospital complications.

Comparing characteristics and outcomes of in-hospital stroke and community-onset stroke (P7-5.028)

<h3>Objective:</h3> The study aims to analyze the characteristics of in-hospital strokes in comparison to community-onset strokes and provides evidence for the development of national in-patient stroke care systems. <h3>Background:</h3> In-hospital strokes account for 4–17% of all strokes and usually lead to urgent and severe conditions. However, features of in-hospital strokes have been scarcely reported in China, and the management systems of in-hospital strokes are unestablished. Evidence from the IHS population is in need to improve the management of in-hospital acute ischemic stroke. <h3>Design/Methods:</h3> We retrospectively analyzed consecutive patients with in-hospital strokes (IHS group) and community-onset strokes (COS group) hospitalized in our hospital between June 2012, and January 2022. Clinical characteristics, care measures, and outcomes were compared between the two groups. <h3>Results:</h3> A total of 1162 patients (age 61 ± 16 and 65% male) were included, of whom 193 (16.6%) had an in-hospital stroke and 969 (83.4%) had community-onset stroke. Compared with COS group, patients in IHS group had higher NIHSS at onset (7.25 vs 5.96, P = 0.054), higher use of endovascular therapy (10.4% vs 2.0%, P &lt; 0.001), and lower use of intravascular thrombolysis (1.6% vs 7.2%, P = 0.003). Also, in-hospital strokes were associated with lower rate of mRS0–2 at discharge (OR[95%CI] = 0.674[0.49, 0.926], P = 0.015) and increased in-hospital mobility (OR[95%CI] = 3.621[1.640, 7.996], P = 0.001), after adjusting for age, sex, and cardiovascular risk factors. <h3>Conclusions:</h3> Compared with community-onset strokes, the patients with in-hospital stroke had insufficient urgent treatment and poorer outcomes, reflecting the need for increased awareness of in-patient stroke, and strategies to streamline in-hospital acute stroke care. <b>Disclosure:</b> Zi-Yue Liu has nothing to disclose. Mr. Han has nothing to disclose. Dr. Wu has nothing to disclose. Ms. Sha has nothing to disclose. Ms. Hong has nothing to disclose. Han-Hui Fu has nothing to disclose. Lixin Zhou has nothing to disclose. Jun Ni has nothing to disclose. Yi-Cheng Zhu has nothing to disclose.

Stroke Systems of Care Are Not Up to Speed for Delivery of New Therapies to More Patients

Stroke Systems of Care Are Not Up to Speed for Delivery of New Therapies to More Patients

Abstract Number ‐ 109: Mechanical Thrombectomy Hands‐on Skill Workshop for MT2020+ in the Caribbean

Introduction While mechanical thrombectomy (MT) is proven to be lifesaving and disability‐sparing, there remains disparities in access in low‐ to middle‐income countries (LTMICs), including the Caribbean. We hypothesized that team‐oriented MT workshops would improve MT skills and change practice patterns for MT services in this region. Methods We designed a 22‐hour MT workshop which was conducted as two identical events: in English (Jamaica, January 2022), and in Spanish (Dominican Republic, May 2022). The workshops included neurointerventional teams (practicing neurointerventionalists, neuroIR nurses and technicians), focused on patient selection, acutetreatment and post‐MT care of patients with stroke due to large vessel occlusion. MT skills, procedure duration and potential harmful techniques were recorded before and after by independent evaluators utilizing flow models under fluoroscopy. Overall course evaluation was performed. Press conferences were included to raise stroke awareness and emphasize the importance of early stroke presentation. Results Twenty‐two physicians and their teams from eight countries across the Caribbean completed the didactic and hands‐on training. Eighteen groups completed both pre‐ and post‐MT hands‐on testing and were included in the final analysis. Pre‐ and post‐course hands‐on assessment showed that the course effectively reduced the total time to complete a simulated MT procedure from 36.5 to 21.1 min (Figure 1; p&lt; 1.0×10‐7). All groups showed an improvement in measures of good MT techniques, which resulted in a 39% improvement in complete reperfusion (8/18 groups achieved a TICI 3 score on pre‐course vs. 15/18 groups on post‐course). There was a significant reduction in total potentially dangerous maneuvers by 82% (p&lt; 0.002), with 12/18 groups performing an average 2 dangerous maneuvers on pre‐course simulation vs. only 4/18 groups performing an average 1 dangerous maneuver after completing the course. Participants also demonstrated increased knowledge of stroke treatment and stroke system of care. Utilizing a basic stroke knowledge questionnaire, we found 28% respondents did not have a baseline passing grade vs 100% passed after the workshop. The average post‐workshop knowledge score was 80%. Universally the workshop was rated as very satisfactory and likely to change practice in 93% of the Dominican Republic participants and 75% among Jamaican participants. Conclusions A team‐based approach to MT training is novel, effective in reducing time to reperfusion and harmful techniques, and improves competencies. Team members independently demonstrated advanced stroke learning post‐training. To our knowledge, this is the first workshop of its kind; it is feasible, practice‐changing and creates a pathway for increasing access to MT in LTMICs.

Abstract Number ‐ 65: US Comprehensive Stroke Center Utilization of FAST and BEFAST Mnemonics for Public Education

Introduction Symptom recognition and timely access to treatment are critical components of acute stroke care systems. Two mnemonics widely used in public educational campaigns for recognizing stroke symptoms include FAST (Face‐Arm‐Speech‐Time) and BEFAST (Balance‐Eyes‐Face‐Arm Speech‐Time). The FAST mnemonic, endorsed by the AHA/ASA can miss up to 14% of strokes. BEFAST includes common posterior circulation stroke symptoms and has been implemented by several Comprehensive Stroke Centers (CSCs). Methods We sought to analyze the pattern of public educational materials available on the websites US CSCs. The Joint Commission (JC) quality check website compiles a list containing the names and locations of the country’s 217 JC‐certified CSCs, which was downloaded in August, 2022. Each CSC’s website was searched for educational material containing FAST and BEFAST mnemonics for stroke symptom recognition. Results The FAST mnemonic was listed by 35%of CSCs, the BEFAST by 58%, with 7% listing no specific mnemonic. The highest portion of CSCs using BEFAST was in western (65%) and southeastern (63%) states. The highest percentage of CSCs with no listed mnemonic were in the northeastern (14%) and southeastern (13%) states. Conclusions Consistency is critical in shaping public health education related to stroke symptoms. Our study suggests further effort is needed to unify the public messaging on stroke recognition.

Stroke profile and care during the COVID-19 pandemic: What changed and what did not? A prospective cohort from Joinville, Brazil.

The COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset. Prospective population-based data about stroke care in the pandemic are limited. This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville, Brazil. A prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville, Brazil, and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before. Patients with transient ischemic attack (TIA) or stroke had their profiles, incidences, subtypes, severity, access to reperfusion therapy, in-hospital stay, complementary investigation, and mortality compared. The profiles of TIA/stroke patients in both periods were similar, with no differences in gender, age, severity, or comorbidities. There was a reduction in incidence of TIA (32.8%; p = 0.003). In both periods, intravenous thrombolysis (IV) and mechanical thrombectomy (MT) rates and intervals from door to IV/MT were similar. Patients with cardioembolic stroke and atrial fibrillation had their in-hospital stay abbreviated. The etiologic investigation was similar before and during the pandemic, but there were increases in cranial tomographies (p = 0.02), transthoracic echocardiograms (p = 0.001), chest X-rays (p < 0.001) and transcranial Doppler ultrasounds (p < 0.001). The number of cranial magnetic resonance imaging decreased in the pandemic. In-hospital mortality did not change. The COVID-19 pandemic is associated with a reduction in TIA, without any influence on stroke profile, the quality of stroke care, in-hospital investigation or mortality. Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemic's negative effects, even with scarce resources.

Abstract WMP24: Developing Interactive Maps To Visualize Wisconsin’S Regional Stroke Systems Of Care

Background and Purpose: Many rural patients experiencing complex strokes are transferred from small hospitals with limited stroke-specific resources (spoke) to larger hospitals (hub). The Wisconsin (WI) Coverdell Stroke Program (Coverdell) utilized the Get with the Guidelines®-Stroke registry to determine the frequency of this spoke-to-hub transfer occurrence in WI in 2020, which was found to be 24.6%. This suggested a need for interactive maps to visualize stroke systems of care (SSoC) linkages between hubs and spoke hospitals across Wisconsin. Methods: In 2021, Coverdell partnered with eight Stroke Coordinators across five WI public health regions. Stroke Coordinators identified hospital transfer connections in their region where transfers occurred 25% or more of the time. With this data, Coverdell developed maps to visualize transfer lines between hospitals with estimated driving distances and transport times via ambulance. User testing, promotion, and publishing to the WI Department of Health Services Chronic Disease website was completed in April 2022. Findings: As of July 1, 2022, our maps have had 389 page views and 272 unique page views. These counts exclude DHS Internet Protocol traffic. Our interactive maps visualize transfers across WI and allow users to select individual hospitals to investigate relationships. We discovered a paucity of certified hospitals and stroke transfers in rural and northern WI. Conclusion: These maps can assist hospitals and Emergency Medical Service providers to visually identify where stroke patients are transported to. In addition, they can help state stroke programs and partners to recognize gaps in SSoC. The maps are a resource for those working with high-risk stroke populations to understand resources available in their communities and wider geographic areas. They also provide a visual representation for policy makers of locations where stroke services may be inadequate.

Abstract 68: Socioeconomic Factors Associated With Ems-documented Stroke Chief Complaints In The Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS)

Background: Accurate identification of stroke by EMS is necessary for triage and pre-notification within stroke systems of care. Our objective was to describe disparities in the documentation of stroke as the patient’s chief complaint (CC) by EMS in a large population-based stroke study. Methods: We included physician-adjudicated strokes and TIAs occurring among adults ≥18 years old in 2015 in the GCNKSS study population, based in a 5-county area of Southern Ohio/Northern Kentucky. Strokes in which EMS was not used and events occurring in the hospital, during EMS transport, at an unknown location, or outside the study region were excluded. The documented CC by EMS (stroke/CVA, MI, seizure, fall, weakness/numbness, headache, or other) were compared between race/sex subgroups. Sequential multivariable logistic regression was performed to identify associations between race, sex, and social determinants of health with an EMS-documented stroke CC. Social determinants included living arrangement and census tract social deprivation index (SDI). Results: A total of 1451 stroke/TIA events were included. White women had the highest proportion of EMS-documented stroke CCs (56%), more than Black women (48%), White men (45%), and Black men (42%), (p=0.02). Black race was inversely associated with an EMS-documented stroke CC in initial models but was collinear with SDI and no longer significant when SDI was included. In the full model, age, previous stroke, and living with others were associated with an EMS-documented stroke CC, while SDI and CAD were inversely associated with EMS-documented stroke CCs. (Table) Conclusion: Patients living in census tracts characterized by social deprivation were less likely to have EMS-documented stroke CCs, suggesting differences in either patient or EMS recognition of stroke. Further work is needed to explore potential confounders including EMS protocols and to improve identification of stroke by patients and EMS providers.

Abstract TP56: Us Comprehensive Stroke Center Utilization Of FAST And BEFAST Mnemonics For Public Education

Introduction: Symptom recognition and timely access to treatment are critical components of acute stroke care systems. Two mnemonics widely used in public educational campaigns for recognizing stroke symptoms include FAST (Face-Arm-Speech-Time) and BEFAST (Balance-Eyes-Face-Arm Speech-Time). The FAST mnemonic, endorsed by the AHA/ASA can miss up to 14% of strokes. BEFAST includes common posterior circulation stroke symptoms and has been implemented by several Comprehensive Stroke Centers (CSCs). Methods: We sought to analyze the pattern of public educational materials available on the websites of US CSCs. The Joint Commission (JC) quality check website compiles a list containing the names and locations of the country’s 217 JC-certified CSCs, which was downloaded in August, 2022. Each CSC’s website was searched for educational material containing FAST and BEFAST mnemonics for stroke symptom recognition. Results: The FAST mnemonic was listed by 35% of CSCs, the BEFAST by 58%, with 7% listing no specific mnemonic. The highest portion of CSCs using BEFAST was in western (65%) and southeastern (63%) states. The highest percentage of CSCs with no listed mnemonic were in the northeastern (14%) and southeastern (13%) states. Conclusions: Consistency is critical in shaping public health education related to stroke symptoms recognition. Our study suggests further effort is needed to unify the public messaging on stroke recognition.

Thrombectomy-Capable Stroke Centre-A Key to Acute Stroke Care System Improvement? Retrospective Analysis of Safety and Efficacy of Endovascular Treatment in Cardiac Cathlab.

The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion are treated, a new entity-thrombectomy-capable stroke centre (TCSC)-was introduced to respond to the growing demand for timely endovascular treatment. The purpose of this study was to present the early experience of the first 70 patients treated by mechanical means in a newly developed cardiac Cathlab-based TCSC. The essential safety and efficacy measures were recorded and compared with those reported in the invasive arm of the HERMES meta-analysis-the largest published dataset on the subject. We found no significant differences in terms of clinical and safety outcomes, such as early neurological recovery, level of functional independence at 90 days, symptomatic intracranial haemorrhage, parenchymal haematoma type 2, and mortality. These encouraging results obtained in the small endovascular centre may be an argument for the introduction of the TCSC into operating stroke networks to increase patient access to timely treatment and to improve clinical outcomes.

Redesigning Rural Acute Stroke Care: A Person-Centered Approach.

Stroke service delivery in rural areas in Australia lacks evidence-based, best practice care protocols as a result of limited resources and opportunity. Healthcare redesign is an approach to improving health services by understanding barriers and enablers to service provision and work with users to develop solutions for improvement. This research aimed to qualitatively evaluate stroke care in rural Tasmania using a person-centered approach, as part of a larger healthcare redesign initiative to improve acute stroke care. Semi-structured interviews, aimed at gaining insight into experiences of healthcare staff and users, were conducted. Thematic analysis revealed three global themes (communication, holistic care, and resourcing) that demonstrated some consistency between healthcare staff and user experience, highlighting that some needs and expectations were not being met. Results of this experiential study provide important perspectives for delivering needs-based improvements in service provision for acute stroke care. Overall, this study showed that systems of stroke care in rural areas could be improved by utilizing a redesign approach including healthcare staff and users in the development of solutions for health service improvement.

Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke

Background With recent trials demonstrating benefit of endovascular thrombectomy (EVT) up to 24 hours from last known well time (LKWT), emergency medical services systems must consider stroke center routing for patients with LKWT ≤24 hours. We sought to determine the frequency of thrombectomy by prehospital‐determined LKWT using retrospective data from a tiered regional stroke care system. Methods During the July 2018 to March 2019 study period, patients with potential large‐vessel occlusion, based on a Los Angeles Motor Scale of 4 or 5, were routed directly to a designated EVT center if within 30 minutes. We determined the frequency of thrombectomy by time intervals from prehospital‐determined LKWT to first medical contact. Results Emergency medical services transported 830 patients with acute ischemic stroke with documented prehospital‐determined LKWT ≤24 hours to EVT centers. The ≤6 hours, &gt;6 to ≤16 hours, and &gt;16 to ≤24 hours epochs accounted for 75%, 20%, and 5% of transports to EVT centers, respectively. Men accounted for 47% of the study population, with a median age of 77 years (interquartile range, 64–86 years) and National Institutes of Health Stroke Scale median of 11 (interquartile range, 4–20). Overall, 28.2% (234/830) received EVT. Time window–specific EVT frequencies were: ≤6 hours (29.8% of patients [187/627]); &gt;6 to ≤16 hours (24.1% of patients [39/162]); and &gt;16 to ≤24 hours (19.5% of [8/41]). Conclusion In this regional stroke system with 2‐tiered routing, patients in the &gt;6‐ to 24‐hour postonset window accounted for nearly one fourth of transports to EVT centers and 23% received thrombectomy.

Interactive Direct Interhospital Transfer Network System for Acute Stroke in South Korea.

Interhospital transfer is an essential practical component of regional stroke care systems. To establish an effective stroke transfer network in South Korea, an interactive transfer system was constructed, and its workflow metrics were observed. In March 2019, a direct transfer system between primary stroke hospitals (PSHs) and comprehensive regional stroke centers (CSCs) was established to standardize the clinical pathway of imaging, recanalization therapy, transfer decisions, and exclusive transfer linkage systems in the two types of centers. In an active case, the time metrics from arrival at PSH ("door") to imaging was measured, and intravenous thrombolysis (IVT) and endovascular treatment (EVT) were used to assess the differences in clinical situations. The direct transfer system was used by 27 patients. They stayed at the PSH for a median duration of 72 min (interquartile range [IQR], 38-114 min), with a median times of 15 and 58 min for imaging and subsequent processing, respectively. The door-to-needle median times of subjects treated with IVT at PSHs (n=5) and CSCs (n=2) were 21 min (IQR, 20.0-22.0 min) and 137.5 min (IQR, 125.3-149.8 min), respectively. EVT was performed on seven subjects (25.9%) at CSCs, which took a median duration of 175 min; 77 min at the PSH, 48 min for transportation, and 50 min at the CSC. Before EVT, bridging IVT at the PSH did not significantly affect the door-to-puncture time (127 min vs. 143.5 min, p=0.86). The direct and interactive transfer system is feasible in real-world practice in South Korea and presents merits in reducing the treatment delay by sharing information during transfer.

Imperfect Patients: Disparities in Treatment of Stroke Patients with Premorbid Disability.

Despite the high proportion of stroke patients with a pre-existing impairment, patients with disabilities are often excluded from stroke treatment trials. Trials are designed for "perfect patients": patients who are functionally independent and thus generally younger with fewer comorbidities; ironically, such patients are less likely to experience stroke than those with premorbid disability. Exclusionary practices in trials may translate into disparities in stroke care in practice. Through a review of literature, our purpose is to illuminate how people with disabilities are treated across the care continuum following a stroke. We completed a qualitative systematized review of articles pertaining to the care of patients with premorbid disability and stroke and their outcomes. Using a critical disability studies' theoretical lens, we analyzed inequity across the stroke care continuum. Among 24 included studies, we found evidence that people with disabilities did not receive equitable access to treatment ranging from being admitted to stroke units to receiving post-stroke rehabilitation. However, observational studies suggest that stroke therapies may be beneficial in selected patients with disabilities when measures of success are framed more achievable (e.g. return to pre-stroke status). This leaves us concerned about how people with pre-existing impairments might be structurally disabled within current systems of stroke care. We use our critical disability studies' theoretical lens to argue that an intersectional approach to stroke treatment is much needed if we are to remedy structural inequities embedded throughout the care continuum.

Measuring Stroke Quality: Methodological Considerations in Selecting, Defining, and Analyzing Quality Measures.

Knowledge about stroke and its management is growing rapidly and stroke systems of care must adapt to deliver evidence-based care. Quality improvement initiatives are essential for translating knowledge from clinical trials and recommendations in guidelines into routine clinical practice. This review focuses on issues central to the measurement of the quality of stroke care, including selection and definition of quality measures, identification of the eligible patient cohorts, optimization of data quality, and considerations for data analysis and interpretation.

Comparing characteristics and outcomes of in-hospital stroke and community-onset stroke.

In-hospital strokes account for 4-17% of all strokes and usually lead to urgent and severe conditions. However, features of in-hospital strokes have been scarcely reported in China, and the management systems of in-hospital strokes are unestablished. The study aims to analyze the characteristics of in-hospital strokes in comparison to community-onset strokes and provides evidence for the development of national in-patient stroke care systems. We retrospectively analyzed consecutive patients with in-hospital strokes (IHS group) and community-onset strokes (COS group) hospitalized in our hospital between June 2012, and January 2022. Clinical characteristics, care measures, and outcomes were compared between the two groups. A total of 1162 patients (age 61 ± 16 and 65% male) were included, of whom 193 (16.6%) had an in-hospital stroke and 969 (83.4%) had community-onset stroke. Compared with COS group, patients in IHS group had higher NIHSS at onset (7.25 vs 5.96, P = 0.054), higher use of endovascular therapy (10.4% vs 2.0%, P < 0.001), and lower use of intravascular thrombolysis (1.6% vs 7.2%, P = 0.003). Also, in-hospital strokes were associated with lower rate of mRS0-2 at discharge (OR[95%CI] = 0.674[0.49, 0.926], P = 0.015) and increased in-hospital mobility (OR[95%CI] = 3.621[1.640, 7.996], P = 0.001), after adjusting for age, sex, and cardiovascular risk factors. Compared with community-onset strokes, the patients with in-hospital stroke had insufficient urgent treatment and poorer outcomes, reflecting the need for increased awareness of in-patient stroke, and strategies to streamline in-hospital acute stroke care.