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Predictors of hospital readmission 1 year after ischemic stroke
Alexandra Leitão1, Anabela Brito2, João Pinho3
1Internal Medicine Department, Hospital Santa Maria Maior, Campo da República, 4754-909, Barcelos, Portugal.
Insights
One-third of ischemic stroke survivors are readmitted within a year, often due to infections. Stroke severity, early CT scan findings, and intravenous thrombolysis (IVT) predict these readmissions.
Area of Science:
- Neurology
- Public Health
- Medical Imaging
Background:
- Predictors of short-term readmission after ischemic stroke are known.
- Few studies have investigated long-term readmission predictors, particularly early imaging findings and intravenous thrombolysis (IVT).
Purpose of the Study:
- To identify predictors of hospital readmission within the first year following an ischemic stroke hospitalization.
- To analyze the impact of early imaging and IVT on long-term readmission rates.
Main Methods:
- Retrospective cohort study of ischemic stroke patients admitted in 2013.
- Data collected from electronic health records and the Portuguese electronic Health Data Platform.
- Statistical analyses included descriptive, univariate, Kaplan-Meier survival, and Cox regression models.
Main Results:
- 165 out of 480 patients (34.4%) experienced 1-year readmissions.
- Leading causes for readmission were infections (43.8%), stroke/TIA recurrence (13.2%), and cardiac diseases (6.4%).
- Independent predictors of readmission included higher admission NIH Stroke Scale scores and mild/absent early ischemic signs on CT, while IVT was protective.
Conclusions:
- Hospital readmission within the first year affects one-third of ischemic stroke patients and is linked to significant in-hospital mortality.
- Clinical stroke severity, early CT findings, and IVT are crucial independent predictors of 1-year readmission.
- Understanding these predictors can inform strategies to reduce readmission rates and improve patient outcomes.
Abstract:
Predictors of short-term readmission after ischemic stroke have been previously identified, but few studies analyzed predictors of long-term readmission, namely early imaging findings and treatment with intravenous thrombolysis (IVT). To characterize predictors of hospital readmission during the first year after hospitalization for ischemic stroke. The study consists of a retrospective cohort of consecutive ischemic stroke patients admitted in a Portuguese university hospital during 2013, who survived index hospitalization. We collected clinical and imaging information using the electronical clinical record. Information concerning 1-year unplanned hospital readmissions was assessed using the Portuguese electronic Health Data Platform. Descriptive and univariate analyses, Kaplan-Meier survival curve and multivariate survival analysis with Cox regression model were used. We included 480 patients, 50.6 % women, median age 79 years (interquartile range = 68-85). One-year hospital readmissions occurred in 165 patients [34.4 %, 95 % confidence interval (95 % CI) 30.2-38.7]. The main causes for readmission were infectious diseases (43.8 %), ischemic stroke or transient ischemic attack recurrence (13.2 %) and cardiac diseases (6.4 %). In-hospital mortality associated with readmission was 23.0 %. The independent predictors of 1-year hospital readmission after ischemic stroke were admission mini-National Institute of Health Stoke Scale [hazards ratio (HR) 1.05, 95 % CI 1.02-1.08, p = 0.002], and mild or absent early signs of ischemia on admission computed tomography (CT) (HR 0.54, 95 % CI 0.32-0.91, p = 0.021) and IVT (HR 0.11, 95 % CI 0.01-0.80, p = 0.029). Hospital readmission during the first year after ischemic stroke occurs in 1/3 of patients and is associated with high in-hospital mortality. Clinical stroke severity, early signs of ischemia on admission CT, and treatment with IVT are independent predictors of 1-year hospital readmission.
