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Title: Outcomes for Patients With In-Hospital Stroke: A Multicenter Study From the Australian Stroke Clinical Registry (AuSCR).
Austin Authors: Cadilhac, Dominique A;Kilkenny, Monique F;Lannin, Natasha A;Dewey, Helen M;Levi, Christopher R;Hill, Kelvin;Grabsch, Brenda;Grimley, Rohan;Blacker, David;Thrift, Amanda G;Middleton, Sandy;Anderson, Craig S;Donnan, Geoffrey A 
Affiliation: Sunshine Coast Clinical School, The University of Queensland, Birtinya, Australia
Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
George Institute for Global Health, University of Sydney, Sydney, Australia
Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, Australia
Sir Charles Gairdner Hospital, Perth, Australia
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
School of Allied Health (Occupational Therapy), La Trobe University, Heidelberg, Australia
Hunter Medical Research Institute, Newcastle, Australia
Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Stroke Foundation, Melbourne, Australia
Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Box Hill, Australia
Occupational Therapy Department, Alfred Health, Prahran, Australia
Issue Date: May-2019
Date: 2019-02-26
Publication information: Journal of Stroke and Cerebrovascular Diseases 2019; 28(5): 1302-1310
Abstract: The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. To explore differences in long-term outcomes among patients with in-hospital events treated in stroke units (SUs) compared to those managed in other hospital wards. Forty-five hospitals participating in the Australian Stroke Clinical Registry between January 2010 and December 2014 contributed data. Survival of all patients with in-hospital stroke to 180 days after stroke and health-related quality of life, using EQ-5D-3L among 73% eligible, were compared using multilevel, multivariable regression models. Models were adjusted for age, sex, index of relative socioeconomic disadvantage, ability to walk, stroke type, transfer from another hospital, and history of stroke. Among 20,786 stroke events, 1182 (5.1%) occurred in-hospital (median age 77 years, 49% male). Patients with in-hospital stroke treated in SUs died less often within 30 days (Hazard Ratio 0.56; 95% CI 0.39-0.81) than those not admitted to SUs. Survivors reported similar health-related quality of life between 90 and 180 days compared to those treated in other wards (coefficient = 0.01, 95% CI -0.06-0.09, P = .78). Patients managed in SUs more often received recommended management (e.g. swallowing screening). The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.
DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.026
Journal: Journal of Stroke and Cerebrovascular Diseases
PubMed URL: 30824298
Type: Journal Article
Subjects: Stroke
Stroke management
Stroke unit
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