ArticlePloS one2019
A comparison of trends in stroke care and outcomes between in-hospital and community-onset stroke - The South London Stroke Register.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Article
- What Are the Predictors of Acute Care Nurses' Stroke Knowledge?: Empirical Research Quantitative.Nursing open · 2024Article
- Validation of the prehospital stroke scales as a tool for in-hospital large vessel occlusion stroke: whether we satisfied?Acta neurologica Belgica · 2024Article
- Heart-brain interactions: clinical evidence and mechanisms based on critical care medicine.Frontiers in cardiovascular medicine · 2024Review
- Characteristics of in-hospital stroke patients in Sweden: A nationwide register-based study.European stroke journal · 2023Article
- Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study.The Lancet regional health. Western Pacific · 2023Article
- Delivering acute stroke care in a middle-income country. The Mexican model: "ResISSSTE Cerebro".Frontiers in neurology · 2023Article
- Exploring the poststroke experiences and unmet needs of South Asian communities in high-income countries: a scoping review protocol.BMJ open · 2022Article
- Admission and Readmission/Death Patterns in Hospitalized and Non-hospitalized First-Ever-in-a-Lifetime Stroke Patients During the First Year: A Population-Based Incidence Study.Frontiers in neurology · 2021Article
- Review
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6 authors.
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Abstract
backgroundStroke care and outcomes have improved significantly over the past decades. It is unclear if patients who had a stroke in hospital (in-hospital stroke, IHS) experienced similar improvements to those who were admitted with stroke (community-onset stroke, COS).
methodsData from the South London Stroke Register were analysed to estimate trends in processes of care and outcomes across three cohorts (1995-2001, 2002-2008, 2009-2015). Kaplan-Meier survival curves were calculated for each cohort. Associations between patient location at stroke onset, processes of care, and outcomes were investigated using multiple logistic regression and Cox proportional hazards models.
resultsOf 5,119 patients admitted to hospital and registered between 1995 and 2015, 552(10.8%) had IHS. Brain imaging rates increased from 92.4%(COS) and 78.3%(IHS) in 1995-2001 to 100% for COS and IHS in 2009-2015. Rates of stroke unit admission rose but remained lower for IHS (1995-2001: 32.2%(COS) vs. 12.4%(IHS), 2002-2008: 77.1%(COS) vs. 50.0%(IHS), 2009-2015: 86.3%(COS) vs. 65.4%(IHS)). After adjusting for patient characteristics and case-mix, IHS was independently associated with lower rates of stroke unit admission in each cohort (1995-2001: OR 0.49, 95%CI 0.29-0.82, 2002-2008: 0.29, 0.18-0.45, 2009-2015: 0.22, 0.11-0.43). In 2009-2015, thrombolysis rates were lower for ischaemic IHS (17.8%(COS) vs. 13.8%(IHS)). Despite a decline, in-hospital mortality remained significantly higher after IHS in 2009-2015 (13.7%(COS) vs. 26.7%(IHS)). Five-year mortality rates declined for COS from 58.9%(1995-2001) to 35.2%(2009-2015) and for IHS from 80.8%(1995-2001) to 51.1%(2009-2015). In multivariable analysis, IHS was associated with higher mortality over five years post-stroke in each cohort (1995-2001: HR 1.27, 95%CI 1.03-1.57, 2002-2008: 1.24, 0.99-1.55, 2009-2016: 1.39, 0.95-2.04).
conclusionsDespite significant improvements for IHS patients similar to those for COS patients, rates of stroke unit admission and thrombolysis remain lower, and short- and long-term outcomes poorer after IHS. Factors preventing IHS patients from entering evidence-based stroke-specific hospital pathways in a timely fashion need further investigation.
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