In-Hospital Ischemic Stroke

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

1. Ethan Cumbler, MD1⇑

1. ¹Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA

1. 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.