Hassanain Toma, MD

Cumbler E, Wald H, Bhatt DL, Cox M, Xian Y, Reeves M, et al. Quality of Care and Outcomes for In-Hospital Ischemic Stroke: FindingsFrom the National Get With The Guidelines-Stroke. Stroke. 2013

A significant number of ischemic strokes occur in patients hospitalized for various medical conditions. Cumbler et al. sought to analyze the quality of care and clinical outcomes for such patients. They used the national Get With The Guidelines-Stroke (GWTG-Stroke) of the American Heart Association to retrospectively compare the care of in-hospital patients to stroke patients that present from the community. Their data suggest that in-hospital stroke patients experienced more severe strokes (NIHSS 9 vs 4), received lower adherence to process-based quality measures (60.8% vs 82.0%), are less likely to ambulate independently (odds ratio 0.42), and have a higher mortality (odds ratio 2.72).




Their finding is shocking to me because I often tell my patients “there is no where better to have a stroke than while hospitalized”.  According to this study, this is clearly not the case! Although, this study showed that in-hospital stroke patients tend to be sicker, the outcomes are the same even after adjusting for multiple variables.  The authors provide a good discussion for the disparity, without clear answers.