Mark L. McAllister, MD

Evaluating an acute ischemic stroke patient in the inpatient setting, our concerns are often focused on determination of stroke etiology and secondary prevention measures, evaluating and treating early complications, and preparing patients for rehabilitation. What happens after the patient leaves the hospital is often a secondary concern. Readmission to the hospital is a common and deleterious outcome for many stroke patients.

The authors here investigated the rates of readmission among stroke patients in Dijon, France. Of 519 patients with first time stroke who survived initial hospitalization, 32% had a hospitalization in the first year after their discharge. The leading cause of admission was neurologic complaints, with stroke or TIA being the most frequent in that category. Unsurprisingly, patients who were older, had more comorbidities, and more severe initial strokes were most likely to have readmission in the year following stroke.

What is not clear in this study is what proportion of hospitalizations were due to preventable causes, and especially causes that were preventable based on actions taking place during the acute hospitalization for stroke. Readmission adversely affects patients’ general level of health and independence, emphasizing the need to minimize preventable readmissions. Finally, the correlation with initial stroke severity and rehospitalization further underscores the need for aggressive primary prevention measures in stroke to avoid these patients’ initial hospitalization.