Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories.

Background and Purpose- Patients with acute cerebral infarcts in multiple arterial territories (MACI) represent a substantial portion of the stroke population. There are no data on short-term outcome and in-hospital complications in patients with MACI. We compared patients with MACI with patients having acute cerebral infarct(s) in a single arterial territory. Methods- We analyzed 3343 patients with diffusion-weighted imaging-confirmed acute cerebral infarcts. MACI was defined as at least 2 acute cerebral ischemic lesions in at least 2 arterial cerebral territories. Patients with MACI were compared with patients with acute cerebral infarct(s) in a single arterial territory for relevant in-hospital complications and short-term outcome, namely National Institutes of Health Stroke Scale and modified Rankin Scale at day 7 after admission or at discharge when earlier. Results- A total of 311 patients (9.3%) met the definition of MACI. Both median National Institutes of Health Stroke Scale (2 [1-7] versus 1 [0-4]) and modified Rankin Scale (3 [1-4] versus 2 [1-3]) were higher in patients with MACI. MACI was independently associated with higher National Institutes of Health Stroke Scale and modified Rankin Scale. Deep venous thrombosis, myocardial infarction, and any complications were more frequent in patients with MACI. Conclusions- In-hospital complications were more frequent in patients with MACI, which may adversely affect short-term clinical and functional outcome. Closer follow-up of patients with MACI during hospitalization may prevent such events and negative progression.

Hospital Readmission after Intracerebral Hemorrhage.

BACKGROUND: Intracerebral hemorrhage (ICH) is the most severe form of stroke, but limited literature exists on readmission after ICH. We aimed to assess frequencies, causes, and predictors of early and late readmissions within 1 year after ICH. METHODS: All patients admitted to the Department of Neurology at Haukeland University Hospital with acute stroke were prospectively included in the Bergen Norwegian Stroke Research Registry (NORSTROKE) registry. Surviving patients diagnosed with ICH were followed by medical chart reviews for 1 year. The first unplanned readmission was used as final outcome, and readmitted patients were defined as early readmitted (≤90 days) and late readmitted (91-365 days). Logistic regression was performed to assess predictors for early and late readmission. RESULTS: Of 121 patients discharged alive, 27 were early readmitted, and 17 were late readmitted. Within 1 year, 40.6% had at least 1 unplanned readmission. The most frequent cause of early readmission was infection, and the most frequent causes for late readmission were recurrent stroke and cardiovascular disease. Nursing home discharge was the only independent predictor of early readmission. Diabetes mellitus and increased length of the index admission were independent predictors of late readmission. Early readmitted patients were older and had more severe stroke and lower levels of fibrinogen on index admission compared with patients who were readmitted late. CONCLUSIONS: Readmission after ICH is frequent, and many patients are early readmitted. Early and late readmissions differed in both causes and predictors for readmission, reflecting different underlying mechanisms for readmission.

Causes and Predictors for Hospital Readmission after Ischemic Stroke.

BACKGROUND: Readmission after stroke is frequent, but limited data are available in Europe. This study aimed at assessing frequencies, causes, and factors associated with early and late unplanned readmissions within 1 year after discharge from ischemic stroke hospitalization. METHODS: All surviving ischemic stroke patients admitted to the Department of Neurology, Haukeland University Hospital, Norway, between July 1, 2007, and June 30, 2012, were followed from discharge until August 1, 2012. Information on readmissions was collected by medical chart reviews. Logistic regression was performed to assess factors associated with early (≤90 days) and late (91-365 days) readmission. RESULTS: Of 1175 patients discharged alive, 18.8% were readmitted within 90 days, and 24.5% were readmitted between day 91 and 365. Most frequent causes were infections, recurrent ischemic stroke, other cardiovascular events, and events related to index stroke. Early readmission was associated with older age, impaired physical function, atherosclerotic etiology of index stroke, and a higher risk factor burden. Late readmission was associated with older age and prior myocardial infarction. Early readmitted patients had shorter length of index admission, poorer physical function and higher frequencies of atherosclerotic etiology of index stroke, atrial fibrillation, and complications with infection during the index admission compared to patients readmitted late. CONCLUSIONS: Readmission after ischemic stroke is frequent, especially in the early period after discharge. Diagnoses and predictors varied according to time point for readmission, reflecting different underlying mechanisms for causes of readmission. Causes of early readmission may include a prothrombotic state and disposition for recurrent infections.