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Updated: May 5, 2026
Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients
Published on: December 16, 2022
A retrospective cohort study reporting outcomes and quality-of-care measures for in-hospital stroke patients using a
Lucy Chapman1, Joan McCormack2, Olga Brych2
1Department of Medical Gerontology, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland.
Insights
In-hospital strokes (IHS) are associated with significantly higher mortality and poorer functional outcomes compared to community-onset strokes (COS). Improving care pathways for IHS patients presents opportunities to reduce delays and improve survival rates.
Area of Science:
- Neurology
- Public Health
- Healthcare Management
Background:
- In-hospital strokes (IHS) represent a significant clinical challenge, accounting for 5.7% of all strokes.
- Patients experiencing IHS are often older and have poorer outcomes compared to community-onset stroke (COS) patients.
Purpose of the Study:
- To compare the characteristics, management, and outcomes of in-hospital strokes versus community-onset strokes.
- To identify areas for improvement in the care of patients experiencing in-hospital strokes.
Main Methods:
- A retrospective multi-centre cohort study utilizing data from the Irish National Audit of Stroke (INAS).
- Comparison of 618 in-hospital stroke cases with community-onset stroke cases between January 2020 and December 2021.
Main Results:
- IHS patients had less frequent admission to stroke units (44.2% vs 70.2%) and longer times to assessment and thrombolysis.
- Mortality was significantly higher for IHS patients (27.2% vs 10.4%), with less likelihood of favorable functional ability at discharge (28.9% vs 52.3%).
- Thrombolysis rates were similar between groups, but delays in assessment and treatment were more pronounced in IHS.
Conclusions:
- In-hospital stroke care requires improvement, particularly regarding timely medical assessment and thrombolysis.
- Addressing delays and optimizing care pathways for IHS patients can potentially reduce mortality and improve functional outcomes.
Introduction:
Between 1% and 17% of strokes occur in-hospital in patients admitted for another reason and are associated with poorer outcomes.
Methods:
A retrospective multi-centre cohort study comparing in-hospital and community-onset strokes was conducted using data collected for the purposes of the Irish National Audit of Stroke (INAS) from the 1st of January 2020 to the 31st of December 2021.
Results:
Of 10,781 stroke cases, 618 cases occurred in-hospital equating to 5.7% of strokes. In-hospital stroke (IHS) patients were older with median age 76 years [Interquartile Range (IQR) 67 to 84 years] versus 74 years [IQR 64 to 82 years] of community-onset stroke (COS). Admission to the stroke unit (SU) was less frequent amongst IHS cases (44.2% versus 70.2% of COS; adjusted Odds Ratio (aOR) 0.46;[95% CI 0.38-0.56]; p < .001). Longer median [IQR] times to assessment (20 [5-84] versus 12 [0-100] minutes; p < .001) and thrombolysis (90 [63-135] versus 54 [37-80] minutes; p < .001) were observed for patients with in-hospital onset compared with COS. Thrombolysis rates were non-significantly lower amongst ischaemic IHS patients (8.7%; n = 45; COS 9.9%; n = 858; p = 0.36). One in four (27.2%) IHS cases died compared with one in ten (10.4%) COS patients (aOR 2.98; [95% CI 2.37-3.75]; p < .001). Favourable functional ability was less likely at discharge amongst the IHS cohort (28.9% versus 52.3%; aOR 0.38; [95% CI 0.30-0.48]; p < .001).
Conclusions:
Analysis of national stroke audit data highlighted potential future opportunities to improve care for IHS patients with longer delays to medical assessment and thrombolysis, poorer functional outcomes and increased in-hospital mortality being observed.
