Don't have a stroke while in the hospital. Ask your hospital president how badly in-hospital strokes fare in their hospital.
In-Hospital Ischemic Stroke
- Ethan Cumbler, MD1⇑
- 1Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
- Ethan Cumbler, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, 12401 E 17th Ave F782, Aurora, CO 80045, USA. Email: ethan.cumbler@ucdenver.edu
Abstract
Between 2.2% and 17% of all strokes have
symptom onset during hospitalization in a patient originally admitted
for another
diagnosis or procedure. These in-hospital strokes
represent a unique population with different risk factors, more mimics,
and substantially worsened outcomes compared to
community-onset strokes. The fact that these strokes manifest during the
acute
care hospitalization, in patients with higher rates
of thrombolytic contraindications, creates distinct challenges for
treatment.
However, the best evidence suggests benefit to
treating appropriately selected in-hospital ischemic strokes with
thrombolysis.
Evidence points toward a “quality gap” for
in-hospital stroke with longer in-hospital delays to evaluation and
treatment,
lower rates of evaluation for etiology, and
decreased adherence to consensus quality process measures of care. This
quality
gap for in-hospital stroke represents a focused
opportunity for quality improvement.
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