Background/Aims
Hospital presentations (emergency department [ED] visits and hospital admissions) are common immediately before first-ever stroke. We aimed to examine differences in the magnitude of associations between hospital presentations and stroke by age, sex or type of stroke.
Methods
This was a case-crossover study using the Tasmanian linked dataset from 2007-2020. First-ever strokes were identified using ICD-10 codes of discharge diagnoses and deaths with an 8-year lookback period. Hospital presentations in the 7-day exposure period before stroke were compared with those within a 1-year control period preceding stroke using conditional logistic regression models and reported as odds ratios (OR) and 95% confidence intervals (CI). Analyses were stratified by age (<65, ≥65-85, >85 years), sex (male, female) and stroke-type (ischemic [IS], hemorrhagic [HS], unspecified [US] stroke).
Results
Among 4,907 first-ever patients (75% aged ≥65 years; 52% men), 9.2% had a hospital presentation within 7 days immediately before stroke. There was a stronger association between previous hospital presentations and stroke in those <65 years (OR 14.75 95% CI 7.20-30.18) than those 65-85 years (OR 5.88 95% CI 4.13-8.38) or >85 years (OR 5.82 95% CI 3.48-9.74). Similar sized associations were found in males (OR 6.75 95% CI 4.65-9.78) and females (OR 7.34 95% CI 4.98-10.82). Associations were stronger for IS (OR 9.23 95%CI 6.15-13.83) and HS (OR 9.08 95%CI 5.00-16.48) than US (OR 3.47 95%CI:2.18-5.53).
Conclusion
Hospital presentations in the 7 days before stroke are common and associated with a high likelihood of stroke, particularly in younger people, warranting further research.