In-Hospital Stroke Patients Wait Longer for Care

Once again we have doctors/researchers that don't keep up with published research. This was written up in May, 2013.

In-hospital strokes get worse care than those presenting to ER, study finds

Pretty much the same study in Canada

In-Hospital Stroke Patients Wait Longer for Care

Up to 17% of strokes occur in patients already hospitalized, but a new Canadian study shows that they wait longer for neuroimaging and thrombolysis than those who have a stroke at home and are brought to the emergency department (ED).
Doctors in hospitals should keep stroke on their radar in the same way that they do for a heart attack, lead study researcher, Alexandra Saltman, MD, resident, core internal medicine, University Health Network, University of Toronto, Ontario, Canada, told Medscape Medical News. "They should keep an open mind that some subtle symptoms may represent stroke, and if they're worried, they should act on it quickly."
Dr Saltman presented the study at the Canadian Stroke Congress in Vancouver, British Columbia.
"Shocking Difference"
For the study the investigators gathered data from charts for all adults with stroke at 11 regional stroke centers in Ontario, Canada, from 2003 to 2012. This included 1048 patients who were admitted to the hospital with another condition and had a stroke while there, and 32,227 who were brought to the hospital after sustaining a stroke. Most hospitalized patients were admitted for medical reasons (30%) or surgery other than cardiac (30%).
The mean age for the entire cohort was 73 years.
To compare "in hospital" and "community-onset" strokes, the authors used the Heart and Stroke Foundation's Canadian stroke best practice recommendations and the American Heart Association (AHA) best practice guidelines for stroke care.
The study results showed that in-hospital patients waited an average of 4.5 hours from the time symptoms were recognized to undergo computed tomography compared with 1.3 hours for patients brought to the ED.
"To me that's a shocking difference," said Dr Saltman.
About 29% of in-hospital stroke patients met the "benchmark" best practice of getting thrombolysis within 90 minutes of symptom onset compared with 72% of patients coming from the community, said Dr Saltman.
In addition, the in-hospital group was less likely to receive thrombolysis (12%) than the group admitted after having a stroke outside the hospital (19%), even if they were eligible for this intervention, she added.
In-hospital patients stayed longer in the hospital (17 days vs 8 days), were more likely to be discharged to a rehabilitation facility (40% vs 32%), and were less likely to be sent home (35% vs 44%).
Although the "in-hospital" patients had more vascular risk factors and comorbidities than the "in-community" group, researchers adjusted for these factors. "We accounted for age, sex, all the vascular comorbidities, stroke severity, and type of stroke, and even when we account for those factors, the in-hospital patients still did worse," said Dr Saltman.

Another page at the link.