Advertisement

Internal and Emergency Medicine

, Volume 12, Issue 1, pp 63–68 | Cite as

Predictors of hospital readmission 1 year after ischemic stroke

  • Alexandra Leitão
  • Anabela Brito
  • João PinhoEmail author
  • José Nuno Alves
  • Ricardo Costa
  • José Manuel Amorim
  • Manuel Ribeiro
  • Inês Pinho
  • Carla Ferreira
IM - ORIGINAL

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.

Keywords

Ischemic stroke Prognosis Readmission Thrombolysis 

Notes

Acknowledgments

Authors would like to thank Dr. Edgar Mesquita (School of Sciences, University of Minho) for helpful statistical advice.

Compliance with ethical standards

Conflict of interest

None.

Statement of human and animal rights

All procedures performed in studies involving human participants are in accordance with the ethical standards of the institutional or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Bennett DA, Krishnamurthi RV, Barker-Collo S, Forouzanfar MH, Naghavi M, Connor M, Lawes CM, Moran AE, Anderson LM, Roth GA, Mensah GA, Ezzati M, Murray CJ, Feigin VL (2014) Global Burden of Diseases, Injuries, and Risk Factors 2010 Study Stroke Expert Group. The global burden of ischemic stroke: findings of the GBD 2010 study. Glob Heart 9:107–112. doi: 10.1016/j.gheart.2014.01.001 CrossRefPubMedGoogle Scholar
  2. 2.
    Lin HJ, Chang WL, Tseng MC (2011) Readmission after stroke in a hospital-based registry: risk, etiologies and risk factors. Neurology 76:438–443. doi: 10.1212/WNL.0b013e31820a0cd8 CrossRefPubMedGoogle Scholar
  3. 3.
    Bravata DM, Ho SY, Meehan TP, Brass LM, Concato J (2007) Readmission and death after hospitalization for acute ischemic stroke: 5-year follow-up in the Medicare population. Stroke 38:1899–1904. doi: 10.1161/STROKEAHA.106.481465 CrossRefPubMedGoogle Scholar
  4. 4.
    Bjerkreim AT, Thomassen L, Brøgger J, Waje-Adreassen U, Næss H (2015) Causes and predictors for hospital readmission after ischemic stroke. J Stroke Cerebrovasc Dis 24:2095–2101. doi: 10.1016/j.jstrokecerebrovasdis.2015.05.019 CrossRefPubMedGoogle Scholar
  5. 5.
    Kilkenny MF, Longworth M, Pollack M, Levi C, Cadilhac DA (2013) Factors associated with 28-day hospital readmission after stroke in Australia. Stroke 44:2260–2268. doi: 10.1161/STROKEAHA.111.000531 CrossRefPubMedGoogle Scholar
  6. 6.
    Lichtman JH, Leifheit-Limson EC, Jones SB, Wang Y, Goldstein LB (2012) 30-day risk-standardized mortality and readmission rates after ischemic stroke in critical access hospitals. Stroke 43:2741–2747. doi: 10.1161/STROKEAHA.112.665646 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lichtman JH, Leifheit-Limson EC, Jones SB, Wang Y, Goldstein LB (2013) Preventable readmissions within 30 days of ischemic stroke among Medicare beneficiaries. Stroke 44:3429–3435. doi: 10.1161/STROKEAHA.113.003165 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Costa R, Pinho J, Alves JN, Amorim JM, Ribeiro M, Ferreira C (2015) Wake-up stroke and stroke within the therapeutic window for thrombolysis have similar clinical severity, imaging characteristics, and outcome. J Stroke Cerebrovasc Dis 25:511–514. doi: 10.1016/j.jstrokecerebrovasdis.2015.10.032 CrossRefPubMedGoogle Scholar
  9. 9.
    Barber PA, Demchuk AM, Zhang J, Bucham AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 355:1670–1674CrossRefPubMedGoogle Scholar
  10. 10.
    Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P, Becker U, Urban G, O’Reilly C, Barber PA, Sharma P, Goyal M, Gahn G, von Kummer R, Demchuk AM (2008) Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke 39:2485–2490CrossRefPubMedGoogle Scholar
  11. 11.
    Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, For the ECASS Investigators (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329. doi: 10.1056/NEJMoa0804656 CrossRefPubMedGoogle Scholar
  12. 12.
    Strowd RE, Wise SM, Umesi UN, Bishop L, Craig J, Lefkowitz D, Reynolds PS, Tegeler C, Arnan M, Duncan PW, Bushnell CD (2015) Predictors of 30-day hospital readmission following ischemic and hemorrhagic stroke. Am J Med Qual 30:441–446. doi: 10.1177/1062860614535838 CrossRefPubMedGoogle Scholar
  13. 13.
    Shah SV, Corado C, Bergman D, Curan Y, Bernstein RA, Naidech AM, Prabhakaran S (2015) Impact of poststroke medical complications on 30-day readmission rate. J Stroke Cerebrovasc Dis 24:1969–1977. doi: 10.1016/j.jstrokecerebrovasdis.2015.04.037 CrossRefPubMedGoogle Scholar
  14. 14.
    Burke JF, Skolarus LE, Adelman EE, Reeves MJ, Brown DL (2014) Influence of hospital-level practices on readmission after ischemic stroke. Neurology 82:2196–2204. doi: 10.1212/WNL.0000000000000514 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Suri MF, Qureshi AI (2013) Readmission within 1 month of discharge among patients with acute ischemic stroke: results of the University HealthSystem Consortium Stroke Benchmarking study. J Vasc Interv Neurol 6:47–51PubMedPubMedCentralGoogle Scholar
  16. 16.
    Kasner SE, Cucchiara BL, McGarvey ML, Luciano JM, Liebeskind DS, Chalela JA (2003) Modified National Institutes of Health Stroke Scale can be estimated from clinical records. Stroke 34:568–570. doi: 10.1161/01.STR.0000052630.11159.25 CrossRefPubMedGoogle Scholar
  17. 17.
    Instituto Nacional de Estatística (2015) Informação à comunicação social—Dia Mundial de Saúde. https://www.ine.pt/ngt_server/attachfileu.jsp?look_parentBoui=227822309&att_display=n&att_download=y. Accessed 4 June 2016

Copyright information

© SIMI 2016

Authors and Affiliations

  • Alexandra Leitão
    • 1
  • Anabela Brito
    • 2
  • João Pinho
    • 3
    Email author
  • José Nuno Alves
    • 3
  • Ricardo Costa
    • 4
  • José Manuel Amorim
    • 5
  • Manuel Ribeiro
    • 6
  • Inês Pinho
    • 1
  • Carla Ferreira
    • 3
  1. 1.Internal Medicine DepartmentHospital Santa Maria MaiorBarcelosPortugal
  2. 2.Internal Medicine Department, Hospital Conde de BertiandosUnidade Local de Saude do Alto MinhoPonte de LimaPortugal
  3. 3.Neurology DepartmentHospital de BragaBragaPortugal
  4. 4.Health Sciences SchoolUniversity of MinhoBragaPortugal
  5. 5.Neuroradiology DepartmentHospital de BragaBragaPortugal
  6. 6.Neuroradiology DepartmentCentro Hospitalar de Vila Nova de GaiaVila Nova de GaiaPortugal

Personalised recommendations