Hospital admission for acute stroke: who, for how long, and to what effect?

Data from 976 patients registered in a community survey as suffering an acute stroke have been analysed to discover what factors are associated with admission to hospital, how long patients spend in hospital, and whether there are any specific benefits attributable to hospital admission. Six hundred and twenty-five patients were admitted on account of their index stroke. These patients were compared with the 249 who remained at home throughout the first six months after the stroke--the remaining patients were admitted for other reasons or had their stroke in hospital. Two major factors related to an increased chance of admission: having a more severe disability and not having a carer. The same factors were associated with a longer length of stay for those who returned home within six months. Nevertheless 26% of patients managed at home were severely disabled when first seen within seven days. Patients admitted had a median stay of seven days if they died, 19 days if they returned home, and 149 days if they needed alternative long-term accommodation. Patients from the study population of 215 000 people occupied an average of 11.4 beds/100 000 over the first six months after their stroke. After making allowance for the increased severity of disability seen in those admitted to hospital, no differences in functional, social or emotional outcome were found for either place of care.