Community Hospital-based Stroke Programs: North Carolina, Oregon, and New York. II: Description of study population.

The three Community Hospital-based Stroke Programs collected data on 4132 stroke patients admitted to acute care hospitals during 1979 and 1980. White female stroke patients were older than the white male, nonwhite female and nonwhite male stroke patients. Nearly one-fourth (23%) of stroke patients were employed at the time of the event. Most (77%) of the patients were hospitalized for first stroke episodes. Eighty-three percent of the patients had at least one of the four major risk factors for stroke, namely, hypertension, diabetes, transient ischemic attacks and cardiac disease. Half (49%) of the patients were alert at the time of admission. The three diagnostic categories included infarction (60%), stroke not otherwise specified (30%) and hemorrhage (10%). Fourteen days was the median length of hospitalization; 50% of the stroke patients were discharged to a home setting, 31% were institutionalized and 19% died while in the hospital. The mean Barthel Index score for 2400 patients at the time of discharge was 61.8 (normal is 100). Of those patients who were working at the time of the stroke, 22% returned to work. In comparison to the patients in the National Survey of Stroke, patients in this Study were less severe at the time of admission (49% of patients in the National Survey of Stroke were stuporous or comatose compared to 21% of the patients in the current Study). The inhospital fatality was 30.7% in the National Survey of Stroke, and 19.7% in the current Study.

Assessment of hospital admission surveillance of stroke in a metropolitan community.

A system of hospital admission surveillance, developed to facilitate the communitywide study of incident stroke, has been evaluated in Monroe County, New York. Of 1604 consecutive patients admitted to the county's seven acute hospitals with a stroke-related diagnosis, 903 were subsequently confirmed as strokes, (predictive value positive = 56%). Among the 701 false positives, 52% were due to TIA or carotid stenosis, while 48% were due to other conditions mimicking stroke. Sensitivity was 68%. Among missed stroke cases 42% were admitted with non stroke-related diagnoses; 25% occurred in hospital; and 32% were missed for clerical reasons. Predictive value positive and sensitivity rates of admission screening were not significantly affected by patient age or sex. In conclusion, admission surveillance has identified a representative sample of hospitalized strokes in a practical and timely manner for studying factors effecting stroke incidence and outcomes on a communitywide basis.