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Comparison of characteristics, management and outcomes in hospital-onset and community-onset stroke: a multi-centre registry-based cohort study of acute stroke.
Fluck, David; Fry, Christopher H; Rankin, Suzanne; Gulli, Giosue; Affley, Brendan; Robin, Jonathan; Kakar, Puneet; Sharma, Pankaj; Han, Thang S.
Afiliación
  • Fluck D; Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
  • Fry CH; School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK.
  • Rankin S; Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
  • Gulli G; Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
  • Affley B; Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
  • Robin J; Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
  • Kakar P; Department of Stroke, Epsom and St Helier University Hospitals, Epsom, KT18 7EG, UK.
  • Sharma P; Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, W6 8RF, UK.
  • Han TS; Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK.
Neurol Sci ; 43(8): 4853-4862, 2022 Aug.
Article en En | MEDLINE | ID: mdl-35322338
OBJECTIVE: Hospital-onset stroke (HOS) is associated with poorer outcomes than community-onset stroke (COS). Previous studies have variably documented patient characteristics and outcome measures; here, we compare in detail characteristics, management and outcomes of HOS and COS. METHODS: A total of 1656 men (mean age ± SD = 73.1 years ± 13.2) and 1653 women (79.3 years ± 13.0), with data prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme, were admitted with acute stroke in four UK hyperacute stroke units (HASU). Associations between variables were examined by chi-squared tests and multivariable logistic regression (COS as reference). RESULTS: There were 272 HOS and 3037 COS patients with mean ages of 80.2 years ± 12.5 and 76.4 years ± SD13.5 and equal sex distribution. Compared to COS, HOS had higher proportions ≥ 80 years (64.0% vs 46.4%), congestive heart failure (16.9% vs 4.9%), atrial fibrillation (25.0% vs 19.7%) and pre-stroke disability (9.6% vs 5.1%), and similar history of stroke, hypertension, diabetes, stroke type and severity of stroke. After age, sex and co-morbidities adjustments, HOS had greater risk of pneumonia: OR (95%CI) = 1.9 (1.3-2.6); malnutrition: OR = 2.2 (1.7-2.9); immediate thrombolysis complications: OR = 5.3 (1.5-18.2); length of stay on HASU > 3 weeks: OR = 2.5 (1.8-3.4); post-stroke disability: OR = 1.8 (1.4-2.4); and in-hospital mortality: OR = 1.8 (1.2-2.4), as well as greater support at discharge including palliative care: OR = 1.9 (1.3-2.8); nursing care: OR = 2.0 (1.3-4.0), help for daily living activities: OR = 1.6 (1.1-2.2); and joint-care planning: OR = 1.5 (1.1-1.9). CONCLUSIONS: This detailed analysis of underlying differences in subject characteristics between patients with HOS or COS and adverse consequences provides further insights into understanding poorer outcomes associated with HOS.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Fibrilación Atrial / Accidente Cerebrovascular Tipo de estudio: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Aged80 / Female / Humans / Male Idioma: En Revista: Neurol Sci Asunto de la revista: NEUROLOGIA Año: 2022 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Fibrilación Atrial / Accidente Cerebrovascular Tipo de estudio: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Aged80 / Female / Humans / Male Idioma: En Revista: Neurol Sci Asunto de la revista: NEUROLOGIA Año: 2022 Tipo del documento: Article