Introduction: In-hospital strokes are often more challenging to treat with acute stroke therapy than strokes that present through the emergency room. It is not well known what percentage of all strokes in a community occur within hospital, or whether the rates of in-hospital stroke are changing over time.
Methods: All stroke events occurring in the hospital for periods 7/1993-6/1994, 1999, 2005, and 2010 in black and white patients ≥ 20 years of age. Events included ischemic stroke, SAH, ICH and TIAs for this analysis. Rates were age, sex and race standardized to the 2000 U.S. population, and reported per 100,000.
Results: A total of 1070 stroke events occurred in the hospital in the four study periods (233, 266, 316, and 255, respectively). Mean (std) age was 72 (13) years at the time of stroke, 635 (59%) were female, and 183 (17%) were black. There were a total of 830 (78%) ischemic strokes, 75 (7%) ICH, 12 (1%) SAH, and 153 (14%) TIAs. This distribution of event type did not change significantly over time. Overall rates by year are shown in the table. Among ischemic strokes, subtype/mechanism did not change significantly by period. Overall, 32 of 830 ischemic strokes (4%) received acute thrombolytic therapy, without significant variation by period. Case fatality at 90 days was significantly higher than for strokes that did not begin in-hospital, as might be expected.
Conclusion: Rates of in-hospital stroke have not changed significantly over time, nor has the rate of acute treatment for ischemic stroke occurring in hospital. This represents a target for system improvement. In-hospital strokes have higher case fatality, likely due to comorbid medical conditions that led to hospital admission.