Background: In-hospital strokes (IHS) comprise 2-17% of all strokes.
Aims: To compare characteristics of ischaemic IHS and COS at our comprehensive stroke centre.
Method: Retrospective review of AusCR data from 01/01/2020 to 29/02/2024.
Results: 1578 strokes occurred over this 38-month period. 1218(77%) were acute ischaemic strokes (AIS), including 45(3.7%) IHS. We excluded haemorrhagic IHS (4 cases, 8.2%) from our analysis. IHS and COS patients were similar in age and gender (median 77 vs 75 yrs; female 44% vs 43%). Most ischaemic IHS occurred on medical and surgical units, with 14(31%) and 13(29%) cases respectively. Cardiology, trauma, stroke, and orthopaedics each had 5(11%). 18(17%) strokes developed post-procedurally, including 11(24%) following a cardiac or vascular procedure. ICU strokes boded the highest mortality (4/7 cases, 57%). Compared to COS, IHS exhibited greater rates of cardiovascular disease (36% vs 13%), heart failure (18% vs 7%), and atrial fibrillation (40% vs 27%). IHS also demonstrated more cardioembolic strokes (51% vs 22%) and large vessel occlusions (44% vs 10%) with greater mortality amongst LVOs (35% vs 15%). In addition, IHS patients presented with more severe strokes (NIHSS 12 vs 4), longer hospital stays (12 vs 4 days), and lower rates of being discharged home (13% vs 50%).
Conclusion: Our data suggests that IHS are more often cardioembolic and fatal than COS, with protracted hospital admissions. The highest risk inpatient areas, including cardiology and surgery, should have targeted training in stroke recognition and heightened awareness for patients with atrial fibrillation and/or CVD.