A Retrospective Cohort Study Reporting Outcomes and Quality-of-Care Measures for In-hospital Stroke Patients Using a National Stroke Audit Database

INTRODUCTION: Between 1% and 17% of strokes occur in-hospital in patients admitted for another reason and are associated with poorer outcomes. METHODS: of December 2021. RESULTS: Of 10,781 stroke cases, 618 cases occurred in-hospital equating to 5.7% of strokes. In-hospital stroke (IHS) patients were older with median age 76 years [Interquartile Range (IQR) 67 to 84 years] versus 74 years [IQR 64 to 82 years] of community-onset stroke (COS). Admission to the stroke unit (SU) was less frequent amongst IHS cases (44.2% versus 70.2% of COS; adjusted Odds Ratio (aOR) 0.46;[95% CI 0.38-0.56]; p<.001). Longer median [IQR] times to assessment (20 [5-84] versus 12 [0-100] minutes; p<.001) and thrombolysis (90 [63-135] versus 54 [37-80] minutes; p<.001) were observed for patients with in-hospital onset compared with COS. Thrombolysis rates were non-significantly lower amongst ischaemic IHS patients (8.7%; n=45; COS 9.9%; n=858; p=0.36). One in four (27.2%) IHS cases died compared with one in ten (10.4%) COS patients (aOR 2.98; [95% CI 2.37-3.75]; p<.001). Favourable functional ability was less likely at discharge amongst the IHS cohort (28.9% versus 52.3%; aOR 0.38; [95% CI 0.30-0.48]; p<.001). CONCLUSIONS: Analysis of national stroke audit data highlighted potential future opportunities to improve care for IHS patients with longer delays to medical assessment and thrombolysis, poorer functional outcomes and increased in-hospital mortality being observed.