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Characteristics of In-Hospital Onset Ischemic StrokeKimura K. · Minematsu K. · Yamaguchi T.
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan
Background and Purpose: The aim of the present study was to clarify the clinical characteristics of in-hospital onset stroke. Material and Methods: We analyzed 15,815 patients with acute brain infarction registered in the Japan Multicenter Stroke Investigators’ Collaboration (J-MUSIC) registry. Results: The in-hospital onset group included 694 (4.4%) patients and the out-of-hospital group included 15,121 (95.6%) patients. Atrial fibrillation (AF) was more common in the in-hospital onset group (34.6%) than in the out-of-hospital group (20.4%, p < 0.001). The admission NIHSS score (median, in-hospital 13 vs. out-of-hospital 5, p < 0.0001) and the mortality rate at discharge were higher in the in-hospital group than in the out-of-hospital group (in-hospital 19.2% vs. out-of-hospital 6.8%, p < 0.0001). On multivariate logistic regression analyses, female gender (OR 1.1, 95% CI 1.1–1.3), older age (OR 1.0, 95% CI 1.02–1.03), AF (OR 4.4, 95% CI 4.0–4.8), history of stroke (OR 1.3, 95% CI 1.2–1.4) and in-hospital stroke onset (OR 3.3, 95 %CI 2.7–3.9) were independent factors associated with severe stroke (NIHSS score ≧11), and older age (OR 1.03, 95% CI 1.02–1.04), the presence of AF (OR 1.21, 95% CI 1.0–1.5), in-hospital stroke onset (OR 1.01, 95% CI 1.01–1.02) and NIHSS score at initial evaluation (OR 1.15, 95% CI 1.14–1.17) were independent factors associated with death at discharge. Conclusion: In-hospital stroke onset was not uncommon. The neurological deficits in patients with in-hospital onset stroke were severer and the outcome was worse than in those with out-of-hospital stroke. Therefore, a strategy to reduce in-hospital stroke onset should be implemented.
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