In-Hospital Stroke Quality and Outcomes in the Mechanical Thrombectomy Era: Get With The Guidelines-Stroke, 2016 to 2023

 Has your competent? hospital addressed these in-hospital stroke failures? Nine+ years and are they still incompetent?

 Stroke outcomes can be worse when they occur in hospital, Canadian study finds December 2016 

Diane and Bob weren't so lucky within the hospital. 

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In-Hospital Stroke Quality and Outcomes in the Mechanical Thrombectomy Era: Get With The Guidelines-Stroke, 2016 to 2023

Amre Nouh, MD, MBA https://orcid.org/0000-0002-9566-5288 nouha@ccf.org, Daiwai Olson, RN, PhD https://orcid.org/0000-0002-9280-078X, 

Hong Liang, PhD https://orcid.org/0000-0002-9148-8894, Ahmed Koriesh, MD, 

Muaz Ali, MD https://orcid.org/0009-0005-1138-4892, Moez M.I. Bashir, MBBS https://orcid.org/0000-0003-0632-9379, 

Pramit Mukerjee, MD https://orcid.org/0000-0002-8717-2395, Shumei Man, MD, PhD https://orcid.org/0000-0002-8345-6470, 

and Gregg C. Fonarow, MD https://orcid.org/0000-0002-3192-8093Author Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.125.054993

Abstract

 In-hospital stroke is associated with delayed recognition and worse outcomes compared with community-onset stroke. Contemporary national data in the mechanical thrombectomy (MT) era are limited. 

METHODS:

 We performed a retrospective cohort study of adult ischemic stroke admissions in the Get With The Guidelines-Stroke registry from January 2016 to December 2023 (the MT era). In-hospital stroke was compared with community-onset stroke as the primary analysis. A secondary descriptive analysis comparing in-hospital patients with stroke from January 2006 to April 2012 and January 2016 to December 2023 was also performed. Primary outcomes were in-hospital mortality, discharge home, and independent ambulation at discharge. Multivariable logistic regression with generalized estimating equations accounted for within-hospital clustering and adjusted for demographics, vascular risk factors/comorbidities, and hospital characteristics. Temporal trends in MT use were assessed with the Cochran-Armitage trend test.

RESULTS:

Among 4 996 392 ischemic stroke admissions from 2016 to 2023, 191 355 (3.8%) were in-hospital, and 4 805 037 (96.2%) were community onset. In-hospital patients presented with greater severity (National Institutes of Health Stroke Scale score >20: 14.5% versus 7.9%; National Institutes of Health Stroke Scale score, 0–4: 43.3% versus 60.4%) had worse outcomes including higher in-hospital mortality (adjusted odds ratio, 2.27 [95% CI, 2.18–2.36]; P<0.001), lower likelihood of discharge home (adjusted odds ratio, 0.46 [95% CI, 0.45–0.48]; P<0.001), and lower independent ambulation at discharge (adjusted odds ratio, 0.52 [95% CI, 0.50–0.53]; P<0.001). Recognition-to-computed tomography time was longer for in-hospital (median 51 [interquartile range, 16–269] versus 18 [10–39] minutes; P<0.001). MT rates increased significantly from 2016 to 2023 in both in-hospital and community-onset patients (4.47%–9.54% and 2.35%–5.55%, respectively; P<0.001). Quality metrics and outcomes significantly improved in the MT era, independent of treatment modality.

CONCLUSIONS:

In patients with in-hospital stroke, MT rates increased over time, and improvements in quality metrics were observed regardless of treatment modality. A higher level of stroke severity and worse outcomes persists.

Graphical Abstract

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