Related Experiment Video
Updated: Sep 6, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Determinants of Prolonged Length of Hospital Stay in Patients with Severe Acute Ischemic Stroke
Kuan-Hung Lin1, Huey-Juan Lin1, Poh-Shiow Yeh1
1Chi-Mei Medical Center, Department of Neurology, 901 Chung-Hwa Road, Yung-Kang District, Tainan 71004, Taiwan.
Insights
Severe acute ischemic stroke patients often experience prolonged hospital stays. These patients, though less likely to die in-hospital, frequently have poor functional outcomes upon discharge.
Area of Science:
- Neurology
- Hospital Administration
- Public Health
Background:
- Long hospitalizations incur significant costs and are linked to higher comorbidity.
- Severe acute ischemic stroke admissions are particularly prone to extended hospital stays.
Purpose of the Study:
- To investigate factors associated with prolonged hospital stays in severe acute ischemic stroke patients.
- To identify strategies for potentially improving length of stay.
Main Methods:
- Prospective Stroke Registry data from January 2019 to June 2020.
- Inclusion criteria: acute ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) ≥ 15.
- Prolonged length-of-stay defined as ≥ 30 days; analysis of clinical characteristics and do-not-resuscitate (DNR) order timing.
Main Results:
- Out of 212 severe stroke patients, 42 (19.8%) had prolonged stays (median 43 days vs. 13 days).
- Prolonged stay group: younger, more males, more independent pre-stroke, received more reperfusion therapy, and had later DNR orders.
- Lower in-hospital mortality (12% vs. 23%) but higher severe functional status (Modified Rankin Scale 4-5) among survivors (97% vs. 87%) in the prolonged group.
Conclusions:
- Severe acute ischemic stroke patients with prolonged stays are younger, predominantly male, and more likely to receive reperfusion therapy.
- These patients were less likely to have early DNR orders and had poorer functional status at discharge, despite lower in-hospital mortality.
Objective:
Long hospitalizations are associated with a high comorbidity and considerable hospital cost. Admissions of severe acute ischemic stroke are prone to longer hospitalizations. We aimed to explore the issue and method for improving the length of stay.
Methods:
From the prospective Stroke Registry between January 2019 and June 2020, acute ischemic strokes with an admission National Institutes of Health Stroke Scale ≥ 15 were identified. Prolonged length-of-stay was defined as in-hospital-stay ≥ 30 days. All clinical characteristics were collected, and all do-not-resuscitate documentations were categorized if the order had been written within 7 days of onset.
Results:
A total of 212 patients were eligible for severe stroke. Of these, 42 (19.8%) had prolonged length-of-stay and 170 had non-prolonged length-of-stay (median 43 vs. 13 days). The prolonged group was younger, mostly men, and was more likely to be in an independent state and more likely to receive reperfusion therapy, and there was a higher frequency of late do-not-resuscitate orders if signed. Although there was a lower in-hospital mortality rate in the prolonged group (12% vs. 23%), there was a higher proportion with a severe functional state (Modified Rankin Scale = 4-5) among the survivors (97% vs. 87%).
Conclusions:
Severe acute ischemic stroke patients with a prolonged length-of-stay were younger, mostly male, more likely to receive reperfusion therapy, less likely to have an early do-not-resuscitate order if signed, and more likely to have poor functional status at discharge, although there was a lower rate of in-hospital mortality.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies