Background:

In‐hospital stroke (IHS) represents 5%–15% of all hospitalized acute stroke cases and is associated with poor outcomes. These patients may be excellent candidates for rapid assessment and potential thrombolytic therapies. This project aimed to study the magnitude of IHS in patients admitted to St. Joseph Mercy Hospital (SJMH), Ann Arbor, Michigan, and to compare the performance of IHS patients with patients admitted with stroke on key Joint Commission stroke quality indicators.

Methods:

This was a retrospective observational study of IHS patients discharged from SJMH from January 2008 to December 2008. Cases included patients discharged with a secondary diagnosis of stroke (ICD‐9 codes 430.0–436.0) during the study period. Patients with a medical history of stroke were excluded based on the documentation of the new CMS modifier “present on admission.” The hospital's quality database was used to retrieve information on demographics, comorbidities, length of stay, discharge disposition, and mortality. Data on quality of care and treatments were obtained by chart review by trained staff. Demographic, clinical, and outcome variables were summarized using means, medians, and percentages, as appropriate. Wilcoxon rank sum tests for continuous variables, Z tests for proportions, and logistic regression analysis for outcome variables were performed.

Results:

Forty‐three patients were identified as having an in‐hospital stroke during the study period. At the time of this interim analysis, data had been entered on 32 of those patients. Mean age was 74 years, 53% were women, and 88% were white. Five of the patients (15%) died in the hospital, 7 (22%) were dead by 30 days, and 9 (28%) by 90 days. In 28 patients, we were able to determine the time of onset of symptoms and calculate the time from onset to completion of the CT scan. Only 19 patients had witnessed onset of symptoms. Of these, 1 had a serious risk for bleeding, 1 had experienced serious side effects from tPA, and 5 were terminally ill. This left 12 patients (42%) eligible for treatment with tPA. None of them received tPA. Fewer than 5% of eligible patients received dysphagia screening or DVT prophylaxis.

Conclusions:

This study identified several opportunities for improving the management of IHS patients at SJMH including timely availability of diagnostics and use of thrombolytic therapies.

Disclosures:

L. Swaminathan ‐ none; S. Hickenbottom ‐ none