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Updated: Jul 18, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
A single-site retrospective review of in-hospital stroke
Lucy Chapman1,2, Orla Kennedy3, David Bradley3,4
1Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland. chapmale@tcd.ie.
Insights
In-hospital strokes have worse outcomes and slower thrombolysis than community-onset strokes. Standardized care is needed for this distinct patient group.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- In-hospital stroke (IHS) occurs during hospital admission for other conditions, representing 2-17% of inpatient strokes.
- Understanding IHS is crucial for improving patient outcomes within healthcare settings.
Purpose of the Study:
- To compare outcomes and quality-of-care for in-hospital strokes versus community-onset strokes.
- To identify specific challenges and disparities in managing IHS.
Main Methods:
- Retrospective cohort study analyzing data from the Irish Annual Audit of Stroke (2020-2021).
- Comparison of baseline characteristics, clinical outcomes, and adherence to stroke quality measures between IHS and community-onset stroke cohorts.
Main Results:
- In-hospital strokes (15.6% rate) were associated with higher rates of COVID-19, intensive care admission, discharge to long-term care, and poorer modified Rankin scores.
- Patients with IHS experienced slower median times to thrombolysis and were less likely to be admitted to a stroke unit.
- While not statistically significant, thrombolysis rates were lower and thrombectomy rates higher in the IHS group.
Conclusions:
- In-hospital stroke is a distinct subgroup with poorer outcomes compared to community-onset stroke.
- Delays in thrombolysis and suboptimal care pathways highlight the need for standardized evaluation and management protocols for IHS.
Background:
In-hospital stroke refers to a stroke arising in a patient during hospital admission for another condition. Between 2 and 17% of all inpatient strokes are in-hospital strokes.
Aim:
To compare the outcomes and performance on quality-of-care stroke measures of in-hospital stroke cases with community-onset strokes.
Methods:
Data collected for the Irish Annual Audit of Stroke from an Irish university teaching hospital was analysed for a 2-year period from 1st January 2020 to 31st December 2021. A retrospective cohort study was conducted to compare baseline characteristics, outcomes, and performance on standardised quality-of-care measures between the cohorts.
Results:
The rate of IHS was 15.6%. Median age was 73 years and 72 years for in-hospital and community-onset strokes respectively. Amongst in-hospital strokes, COVID-19 co-diagnosis (9.1% versus 1.3%; p = .0004), admission to intensive care (52.3% versus 5.3%; p < .0001), discharge to long term care (6.8% versus 2.3%; p = .04), mortality (12.5% versus 7.6%; p = .13), and modified Rankin score of two or more at discharge (58.0% versus 38.1%; p = .001), were more likely compared to community-onset strokes. Thrombolysis rates were lower (7.3% versus 12.0%; p = .22) and thrombectomy rates higher (9.8% versus 6.6;% p = .32), albeit non-significantly. Median time to thrombolysis was slower amongst in-hospital strokes (105 min versus 66 min; p = .03) and they were less likely to be admitted to the stroke unit (43.2% versus 78.5%; p < .0001).
Conclusions:
When compared with community-onset stroke, in-hospital stroke represents a distinct stroke subgroup with poorer outcomes and delays to thrombolysis emphasising the need for standardised approaches to evaluation and management.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
01:17Hemorrhagic Stroke l: Introduction