• Dominique A Cadilhac, Monique F Kilkenny, Natasha A Lannin, Helen M Dewey, Christopher R Levi, Kelvin Hill, Brenda Grabsch, Rohan Grimley, David Blacker, Amanda G Thrift, Sandy Middleton, Craig S Anderson, Geoffrey A Donnan, and Australian Stroke Clinical Registry Consortium.
• Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia; Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia. Electronic address: dominique.cadilhac@monash.edu.
• J Stroke Cerebrovasc Dis. 2019 May 1; 28 (5): 1302-1310.

BackgroundThe quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia.AimsTo explore differences in long-term outcomes among patients with in-hospital events treated in stroke units (SUs) compared to those managed in other hospital wards.MethodsForty-five hospitals participating in the Australian Stroke Clinical Registry between January 2010 and December 2014 contributed data. Survival of all patients with in-hospital stroke to 180 days after stroke and health-related quality of life, using EQ-5D-3L among 73% eligible, were compared using multilevel, multivariable regression models. Models were adjusted for age, sex, index of relative socioeconomic disadvantage, ability to walk, stroke type, transfer from another hospital, and history of stroke.ResultsAmong 20,786 stroke events, 1182 (5.1%) occurred in-hospital (median age 77 years, 49% male). Patients with in-hospital stroke treated in SUs died less often within 30 days (Hazard Ratio 0.56; 95% CI 0.39-0.81) than those not admitted to SUs. Survivors reported similar health-related quality of life between 90 and 180 days compared to those treated in other wards (coefficient = 0.01, 95% CI -0.06-0.09, P = .78). Patients managed in SUs more often received recommended management (e.g. swallowing screening).ConclusionThe benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.Copyright © 2019 Elsevier Inc. All rights reserved.

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