Background and Aims: In hospital stroke (IHS) is defined as a cerebrovascular insult which occurs during hospitalisation in an already admitted patient. Compared to out-of-hospital stroke (OHS), IHS patients have worse outcomes, longer hospital stays, are less likely to be discharged home and have higher long-term mortality. We investigated all IHS at a large regional health centre to gain an understanding of associated clinical aspects and risk factors.
Methods: All adult patients with IHS at a single health service throughout 2019-2023 and registered in Australian Clinical Stroke registry (AusCr) were included. Data were extracted relating to patient demographics, stroke classification and characteristics, known risk factors for stroke, and medication use.
Results: 60 patients (mean age of 73) were identified to have IHS during the 5-year period captured. Population group had a mean modified Rankin score (mRS) of 1. Surgical patients represented 66% of patients, with 64% of all patients being male. Cardioembolic and large vessel disease totalled 37% of strokes each, with haemorrhagic stroke making up 5% of stroke. The most common comorbidities included hypertension (66%), hyperlipidaemia (39%), previous stroke (36%) and diabetes (31%). Stroke occurred after surgical procedures in 39% of total IHS, with 23.7% on anticoagulant or antithrombotic medications pre-admission. Of all patients included, 18.7% had their anti-thrombotic/anti-coagulants withheld prior to stroke.
Conclusion: Understanding potential differences between IHS and OHS are critical in ensuring stroke risk is mitigated during hospitalization, as approaches within the community may need to differ when managing patients within an inpatient environment.