Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
J Neurol. 2022 Oct;269(10):5617-5627. doi: 10.1007/s00415-022-11244-2. Epub 2022 Jul 2.
In-hospital strokes account for 4-17% of all strokes and usually lead to urgent and severe conditions. However, features of in-hospital strokes have been scarcely reported in China, and the management systems of in-hospital strokes are unestablished. The study aims to analyze the characteristics of in-hospital strokes in comparison to community-onset strokes and provides evidence for the development of national in-patient stroke care systems.
We retrospectively analyzed consecutive patients with in-hospital strokes (IHS group) and community-onset strokes (COS group) hospitalized in our hospital between June 2012, and January 2022. Clinical characteristics, care measures, and outcomes were compared between the two groups.
A total of 1162 patients (age 61 ± 16 and 65% male) were included, of whom 193 (16.6%) had an in-hospital stroke and 969 (83.4%) had community-onset stroke. Compared with COS group, patients in IHS group had higher NIHSS at onset (7.25 vs 5.96, P = 0.054), higher use of endovascular therapy (10.4% vs 2.0%, P < 0.001), and lower use of intravascular thrombolysis (1.6% vs 7.2%, P = 0.003). Also, in-hospital strokes were associated with lower rate of mRS0-2 at discharge (OR[95%CI] = 0.674[0.49, 0.926], P = 0.015) and increased in-hospital mobility (OR[95%CI] = 3.621[1.640, 7.996], P = 0.001), after adjusting for age, sex, and cardiovascular risk factors.
Compared with community-onset strokes, the patients with in-hospital stroke had insufficient urgent treatment and poorer outcomes, reflecting the need for increased awareness of in-patient stroke, and strategies to streamline in-hospital acute stroke care.
院内卒中占所有卒中的 4-17%，通常导致紧急和严重的情况。然而，中国鲜有院内卒中特征的报道，且院内卒中管理系统尚未建立。本研究旨在分析与社区发病卒中相比，院内卒中的特征，并为国家住院卒中治疗系统的发展提供证据。
我们回顾性分析了 2012 年 6 月至 2022 年 1 月期间我院收治的连续院内卒中（IHS 组）和社区发病卒中（COS 组）患者。比较两组患者的临床特征、治疗措施和结局。
共纳入 1162 例患者（年龄 61±16 岁，65%为男性），其中 193 例（16.6%）为院内卒中，969 例（83.4%）为社区发病卒中。与 COS 组相比，IHS 组患者发病时 NIHSS 评分更高（7.25 比 5.96，P=0.054），血管内治疗使用率更高（10.4%比 2.0%，P<0.001），血管内溶栓使用率更低（1.6%比 7.2%，P=0.003）。此外，院内卒中与出院时 mRS0-2 评分较低的比例较低（OR[95%CI]为 0.674[0.49，0.926]，P=0.015）和院内活动能力增加相关（OR[95%CI]为 3.621[1.640，7.996]，P=0.001），校正年龄、性别和心血管危险因素后。
与社区发病卒中相比，院内卒中患者的紧急治疗不足，结局较差，反映出需要提高对住院卒中的认识，并制定简化院内急性卒中治疗的策略。
