Nakajima Makoto, Hirano Teruyuki, Uchino Makoto
Department of Medicine, Kumamoto Rosai Hospital, Yatsushiro, Japan.
J Stroke Cerebrovasc Dis. 2008 Nov-Dec;17(6):382-7. doi: 10.1016/j.jstrokecerebrovasdis.2008.05.002.
The aim of this study was to identify the characteristics of patients with stroke who were discharged home despite their need for acute hospital treatment.
This study included 611 consecutive patients with ischemic stroke who were admitted to our hospital within 7 days of stroke onset. The patients were divided into two groups: those directly admitted and those readmitted after having previously been seen at our hospital or other facilities. The patients' characteristics and symptoms at the time of their initial visit were analyzed.
In all, 61 patients (10.0%) were initially discharged. The presence of hypertension, a summer admission, ambulance transport, and evaluation by neurologists were more frequent in the direct admission group than in the nondirect admission group. There was a lower incidence of consciousness disturbance and motor deficits in the nondirect admission group than in the direct admission group. The incidence of visual disturbance, gait disturbance, vertigo or dizziness, nausea, and sensory disturbance was higher in the nondirect admission group than in the direct admission group. On logistic regression model analysis, evaluation by nonneurologists (odds 33.0), hypertension (3.14), absence of consciousness disturbance (5.26), absence of paralysis (2.27), and presence of sensory disturbance (3.45) were independently associated with being initially discharged.
Physicians tend to consider that a patient has no need to be admitted into hospital if the patient is alert, has a sensory disturbance, or has no paralysis.
