scholarly journals Critical Pathway and Hospital-Hospital Cooperation in Acute Stroke Reduction of the Length of Hospital Stay

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 251-255 ◽  
Author(s):  
Y. Hashimoto ◽  
T. Terasaki ◽  
T. Yonehara ◽  
M. Tokunaga ◽  
T. Hirano ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Acute Stroke ◽  
Neurological Disease ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Stroke Patients ◽  
Critical Pathway ◽  
Hospital Days ◽  
Other Neurological Disease

Stroke patients tend to stay longer in one hospital compared to patients with other neurological disease. After the introduction of 3 types of critical pathway dedicated for various severity of acute ischemic stroke in 1995, the average length of in-hospital days declined from 30.0 days (1993) to 15.3 days (1998), ie 49% reduction. This reduction was achieved by the use of critical pathway and the hospital-hospital cooperation.

Prognostic Significance of Hyponatremia in Acute Stroke: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 49 (5) ◽  
pp. 531-539
Author(s):  
Shogo Shima ◽  
Yasunari Niimi ◽  
Yosuke Moteki ◽  
Osamu Takahashi ◽  
Shinsuke Sato ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Stroke ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Stroke Patients

<b><i>Objective:</i></b> Hyponatremia is a common electrolyte disorder in patients with stroke, which leads to various fatal complications. We performed a systematic review and meta-analysis to investigate the outcomes of acute stroke patients with hyponatremia. <b><i>Methods:</i></b> We searched MEDLINE, EMBASE, and the Cochrane Library databases for relevant literature in English published up to March 2020. Two review authors independently screened and selected the studies by assessing the eligibility and validity based on the inclusion criteria. Mortality at 90 days was set as the primary end point, and in-hospital mortality and length of hospital stay were set as the secondary end points. We conducted the data synthesis and analyzed the outcomes by calculating the odds ratio (OR) and mean difference. <b><i>Results:</i></b> Of 835 studies, 15 studies met the inclusion criteria (<i>n</i> = 10,745). The prevalence rate of stroke patients with hyponatremia was 7.0–59.2%. They had significantly higher 90-day mortality (OR, 1.73; 95% confidence interval (CI), 1.24–2.42) and longer length of hospital stay (mean difference, 10.68 days; 95% CI, 7.14–14.22) than patients without hyponatremia. Patients with hyponatremia had a higher tendency of in-hospital mortality than those without hyponatremia (OR, 1.61; 95% CI, 0.97–2.69). <b><i>Conclusions:</i></b> The development of hyponatremia in the clinical course of stroke is associated with higher short-term mortality and a longer hospital stay. Although the causal relationship is unclear, hyponatremia could be a significant predictor of poor outcomes after stroke.

scholarly journals Gravidade do déficit neurológico e incidência de infecções hospitalares em pacientes idosos com acidente vascular cerebral agudo

2016 ◽  
Vol 26 (4) ◽  
pp. 25168
Author(s):  
Lucieni Oliveira Conterno ◽  
Rodrigo Wanderley Neves Barbosa ◽  
Caroline Martins Rego ◽  
Carlos Rodrigues Da Silva Filho
Keyword(s):  
Nosocomial Infection ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Acute Stroke ◽  
Neurological Deficit ◽  
Nosocomial Infections ◽  
Functional Disability ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Time Of Admission

Aims: To evaluate the association between severity of neurological deficit/degree of functional disability and incidence of nosocomial infections, length of hospital stay, and mortality, in elderly patients with acute stroke.Methods: A prospective cohort study evaluated elderly patients with acute stroke, hospitalized at the Hospital of the Marilia Medical School, in Marilia, SP, Brazil. Inclusion criteria were patients aged 60 years or more and diagnosed with acute stroke. Patients were stratified according to the severity of the stroke by the National Institutes of Health Stroke Scale and the degree of dependence by the modified Rankin scale. All patients were followed from the time of admission to discharge or death.Results: We studied 113 patients with a mean age of 70.8 years, 63 (55.7%) men. The main underlying diseases were hypertension (77.9%) and type 2 diabetes mellitus (30.1%). Seventy-eight (69%) patients were affected for the first time and 86 (76.1%) had ischemic stroke. Nosocomial infection occurred in 24 patients (21.2%) and pneumonia was the most frequent (13.5%). The average length of hospital stay among patients with nosocomial infection was higher when compared to those without nosocomial infection (16.2±16.2 days and 33.2±22.9 days, p<0.001). There was association between score 16-42 points on the National Institute of Health Stroke Scale and the occurrence of nosocomial infection (risk ratio 4.4; 95% confidence interval 1.8 to 11.0). In-hospital mortality was 15.9%, higher among patients considered severe at admission compared to those with moderate to mild severity by the National Institute of Health Stroke Scale (34.6% and 1.6% respectively, p<0.001) and also among those who developed nosocomial infection when compared to those without this complication (37.5% and 10.1% respectively, p=0.003).Conclusions: Nosocomial infections were major complications among elderly patients with acute stroke and were associated with severity of neurological deficit, higher degree of dependence, longer hospital stay and higher mortality rate.

Abstract WP54: Early MRI Facilitates Stroke Evaluation and Decreases Length of Stay for Ischemic Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Bharti Manwani ◽  
Subhendu Rath ◽  
Matthew Woodward ◽  
Ilene Staff ◽  
Gilbert Fortunato ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Imaging Modality ◽  
Length Of Hospital Stay ◽  
Hospital Length Of Stay ◽  
Stroke Patients ◽  
Acute Hemorrhage ◽  
Head Ct ◽  
Mri Brain

Background: Imaging studies are an integral part of stroke evaluation and non-contrast head CT is the initial imaging modality. Although critical for assessing acute hemorrhage, ischemic changes may not be visible on CT for up to 24 hours. MRI brain detects ischemic changes within 20 minutes of symptom onset. It is an invaluable tool to confirm an ischemic stroke and determine its etiology. A focused workup for stroke etiology or evaluation for stroke mimics accelerates management strategies and reduces length of stay in the hospital. Early discharge facilitates early rehabilitation and better functional recovery of stroke patients. Current guidelines for management of acute stroke recommend head CT within 25 minutes of presentation. However, to date, a recommendation regarding timeline for MRI brain in stroke evaluation is lacking. Objective of this study was to investigate the correlation between time to MRI & length of hospital stay to functional outcome in stroke patients. Methods: 648 patients (mean age 69±0.5 years; 50.4% women) admitted to Hartford Hospital (Comprehensive Stroke Center) with a focal neurological deficit in the year 2014 and got a CT head and MRI brain were enrolled in the study. Data collection was done via stroke database and retrospective chart review. Patients with any hemorrhage or age<18 years, were excluded from the study. We used Mann-Whitney U and Spearman’s correlation co-efficient to compare time from arrival to MRI and length of stay in the hospital. Results: There was a significant effect of time from arrival to MRI on length of hospital stay (r=0.27, p<0.01). Subgroup analysis revealed a significant decrease in length of stay if MRI was done within 12 hours of admission (p<0.02) as compared to 24 hours or above (p<0.12). Based on MRI findings, 27% patients had a new diagnosis of stroke and in 24.1% patients stroke was ruled out. This change in diagnosis had a significant effect on length of stay (Z=-2.4, p<0.02). Conclusions: Our study indicates that delay in MRI for a suspected stroke increases hospital length of stay. It suggests MRI within 12 hours of admission to be the new standard of care for stroke patients. Ongoing work will assess the correlation of timing to MRI to functional outcomes in stroke patients.

Upgraded Acute Stroke Care Including Thrombolysis Is Associated with Reduced Length of Hospital Stay among Non-Stroke Patients

2008 ◽  
Vol 27 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Christine Sølling ◽  
Søren Påske Johnsen ◽  
Lars Ehlers ◽  
Leif Østergaard ◽  
Grethe Andersen
Keyword(s):  
Hospital Stay ◽  
Acute Stroke ◽  
Length Of Hospital Stay ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Stroke Care

scholarly journals Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke

2020 ◽  
pp. 1-5
Author(s):  
Nikolaos Mouchtouris ◽  
Fadi Al Saiegh ◽  
Breanna Valcarcel ◽  
Carrie E. Andrews ◽  
Evan Fitchett ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Hospital Readmission ◽  
Mechanical Thrombectomy ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Hospital Performance ◽  
National Standards ◽  
Day Hospital ◽  
Stroke Patients

OBJECTIVEThe 30-day readmission rate is of increasing interest to hospital administrators and physicians, as it is used to evaluate hospital performance and is associated with increased healthcare expenditures. The estimated yearly cost to Medicare of readmissions is $17.4 billion. The Centers for Medicare and Medicaid Services therefore track unplanned 30-day readmissions and institute penalties against hospitals whose readmission rates exceed disease-specific national standards. One of the most important conditions with potential for improvement in cost-effective care is ischemic stroke, which affects 795,000 people in the United States and is a leading cause of death and disability. Recent widespread adoption of mechanical thrombectomy has revolutionized stroke care, requiring reassessment of readmission causes and costs in this population.METHODSThe authors retrospectively analyzed a prospectively maintained database of stroke patients and identified 561 patients who underwent mechanical thrombectomy between 2010 and 2019 at the authors’ institution. Univariate and multivariate analyses were conducted to identify clinical variables and comorbidities related to 30-day readmissions in this patient population.RESULTSOf the 561 patients, 85.6% (n = 480) survived their admission and were discharged from the hospital to home or rehabilitation, and 8.8% (n = 42/480) were readmitted within 30 days. The median time to readmission was 10.5 days (IQR 6.0–14.3). The most common reasons for readmission were infection (33.3%) and acute cardiac or cerebrovascular events (19% and 20%, respectively). Multivariate analysis showed that hypertension (p = 0.030; OR 2.72) and length of initial hospital stay (p = 0.040; OR 1.032) were significantly correlated with readmission within 30 days, while hemorrhagic conversion (grades 3 and 4) approached significance (p = 0.053; OR 2.23). Other factors, such as unfavorable outcome at discharge, history of coronary artery disease, and discharge destination, did not predict readmission.CONCLUSIONSThe study data demonstrate that hypertension, length of hospital stay, and hemorrhagic conversion were predictors of 30-day hospital readmission in stroke patients after mechanical thrombectomy. Infection was the most common cause of 30-day readmission, followed by cardiac and cerebrovascular diagnoses. These results therefore may serve to identify patients within the stroke population who require increased surveillance following discharge to reduce complications and unplanned readmissions.

scholarly journals A Study on Predicting the Length of Hospital Stay for Chinese Patients With Ischemic Stroke Based on the XGBoost Algorithm

2021 ◽  
Author(s):  
Chen Rui ◽  
Shengfa Zhang ◽  
Jie Li ◽  
Dongwei Guo ◽  
Weijun Zhang ◽  
...  
Keyword(s):  
Machine Learning ◽  
Ischemic Stroke ◽  
Prediction Model ◽  
Hospital Stay ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Cross Validation ◽  
Length Of Hospital Stay ◽  
Stroke Patients ◽  
Fold Cross Validation

Abstract Background China faced the most significant challenge from stroke because it imposes a heavy burden on families, national health services, social services, and the economy. The length of hospital stay (LOS) was an essential indicator of utilization of medical services and was usually used to assess the efficiency of hospital management and patient quality of care. This study established a prediction model based on the machine learning algorithm to predict the ischemic stroke patients' LOS.MethodsA total of 18,195 ischemic stroke patients' electronic medical records and 28 attributes were extracted from electronic medical records in a large comprehensive hospital in China. After preprocessing the data and feature selection, the XGBoost algorithm was used for building a machine learning model. The 10-fold cross-validation was used for model validation. The accuracy (ACC), recall rate (RE) and F1 measure were used to evaluate the performance of the prediction model of LOS of ischemic stroke patients. Finally, the XGBoost algorithm was used to identify and remove irrelevant features by ranking all attributes based on feature importance.ResultsThe average ACC, RE and F1 measure were 0.96, 0.82 and 0.79, respectively, under the 10-fold cross-validation. According to the analysis of the importance of features, the LOS of ischemic stroke patients was affected by demographic characteristics, past medical history, admission examination features, and operation characteristics. Finally, the features, including NIHSS, MRS, Hemiplegia aphasia, age, BMI and TIA etc. were found to be the top ten features in importance in predicting the LOS of ischemic stroke patients.ConclusionsThe XGBoost algorithm was an appropriate machine learning method for predicting the LOS of patients with ischemic stroke. Based on the prediction model, an intelligent medical management prediction system could be developed to predict the LOS based on ischemic stroke patients' electronic medical records.

scholarly journals Hyperglycemia as a Prognostic Factor In Acute Ischemic Stroke Patients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A E E Abdelhamid ◽  
H A El-Gendy ◽  
M A E Nosseir ◽  
M A Mohamed
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Motor Deficit ◽  
Control Group ◽  
P Value ◽  
Motor Power ◽  
Stroke Patients ◽  
Significant Difference

Abstract Background Hyperglycemia is encountered in 20% to 40% of acute stroke patients, with or without a pre-morbid diagnosis of diabetes mellitus. Hyperglycemia is a risk factor for infarct expansion and poor outcome through the first 72 hours of hospitalization in both diabetics and non-diabetics. Aim of the Work to study the glycemic status after acute ischemic stroke and assess its role in influencing stroke out-come as regards the duration of hospital stay, motor deficit outcome and mortality. Patients and Methods This retrospective study was conducted in Elzaiton specialized hospital and Ain Shams University from June 2016 to June 2017 on 80 patients after approval of local medical ethical committee. Patients with acute ischemic stroke without other major comorbidities within 24 hours of onset of symptoms were evaluated. Results The study revealed that hospital stay mean was 12.04 ± 9.61 (in control group) and 21.36 ± 12.49 (in uncontrolled group), with p-value &lt; 0.022 S. A highly statistically significant difference between controlled and uncontrolled according to increase motor power at ICU admission in controlled a highly statistically significant difference between controlled and uncontrolled according to increase motor power discharge in controlled group. A highly statistically significant difference was found between both groups as regards outcome (mortality). Conclusion Hyperglycemia is common among acute stroke patients and is associate with less favorable outcome as regards mortality, hospital stay and functional outcome and euglycemic control is recommended in these patients.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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