Outcomes for Patients With In-Hospital Stroke: A Multicenter Study From the Australian Stroke Clinical Registry (AuSCR)

Dominique A. Cadilhac, Monique F. Kilkenny, Natasha A. Lannin, Helen M. Dewey, Christopher R. Levi, Kelvin Hill, Brenda Grabsch, Rohan Grimley, David Blacker, Amanda G. Thrift, Sandy Middleton, Craig S. Anderson, Geoffrey A. Donnan, On behalf of the Australian Stroke Clinical Registry Consortium

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. Aims: 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. Methods: 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. Results: 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). Conclusion: The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.

Original languageEnglish
Pages (from-to)1302–1310
Number of pages9
JournalJournal of Stroke and Cerebrovascular Diseases
Volume28
Issue number5
DOIs
Publication statusPublished - 1 May 2019

Keywords

  • hospitals
  • outcome
  • Stroke
  • stroke management
  • stroke unit

Cite this

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. ; On behalf of the Australian Stroke Clinical Registry Consortium. / Outcomes for Patients With In-Hospital Stroke : A Multicenter Study From the Australian Stroke Clinical Registry (AuSCR). In: Journal of Stroke and Cerebrovascular Diseases. 2019 ; Vol. 28, No. 5. pp. 1302–1310.
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title = "Outcomes for Patients With In-Hospital Stroke: A Multicenter Study From the Australian Stroke Clinical Registry (AuSCR)",
abstract = "Background: The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. Aims: 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. Methods: 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. Results: 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). Conclusion: The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.",
keywords = "hospitals, outcome, Stroke, stroke management, stroke unit",
author = "Cadilhac, {Dominique A.} and Kilkenny, {Monique F.} and Lannin, {Natasha A.} and Dewey, {Helen M.} and Levi, {Christopher R.} and Kelvin Hill and Brenda Grabsch and Rohan Grimley and David Blacker and Thrift, {Amanda G.} and Sandy Middleton and Anderson, {Craig S.} and Donnan, {Geoffrey A.} and {On behalf of the Australian Stroke Clinical Registry Consortium}",
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Cadilhac, DA, Kilkenny, MF, Lannin, NA, Dewey, HM, Levi, CR, Hill, K, Grabsch, B, Grimley, R, Blacker, D, Thrift, AG, Middleton, S, Anderson, CS, Donnan, GA & On behalf of the Australian Stroke Clinical Registry Consortium 2019, 'Outcomes for Patients With In-Hospital Stroke: A Multicenter Study From the Australian Stroke Clinical Registry (AuSCR)' Journal of Stroke and Cerebrovascular Diseases, vol. 28, no. 5, pp. 1302–1310. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.026

Outcomes for Patients With In-Hospital Stroke : A Multicenter Study From the Australian Stroke Clinical Registry (AuSCR). / 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.; On behalf of the Australian Stroke Clinical Registry Consortium.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 28, No. 5, 01.05.2019, p. 1302–1310.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Outcomes for Patients With In-Hospital Stroke

T2 - A Multicenter Study From the Australian Stroke Clinical Registry (AuSCR)

AU - Cadilhac, Dominique A.

AU - Kilkenny, Monique F.

AU - Lannin, Natasha A.

AU - Dewey, Helen M.

AU - Levi, Christopher R.

AU - Hill, Kelvin

AU - Grabsch, Brenda

AU - Grimley, Rohan

AU - Blacker, David

AU - Thrift, Amanda G.

AU - Middleton, Sandy

AU - Anderson, Craig S.

AU - Donnan, Geoffrey A.

AU - On behalf of the Australian Stroke Clinical Registry Consortium

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N2 - Background: The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. Aims: 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. Methods: 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. Results: 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). Conclusion: The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.

AB - Background: The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. Aims: 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. Methods: 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. Results: 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). Conclusion: The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.

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