This cohort study uses a large US national registry to assess temporal trends from 2008 to 2018 in the use of intravenous and endovascular reperfusion therapies, process measures of quality, and association between functional outcomes and key patient characteristics, comorbidities, and treatments of in-hospital vs out-of-hospital stroke onset.
Stroke is a well-known complication of acute medical or surgical illnesses. Prior work has shown that patients with stroke occurring in the hospital are more likely to encounter delays in diagnosis, have gaps in care, and experience worse outcomes compared with patients with stroke occurring out of the hospital. Delay in the recognition of symptoms of stroke is particularly relevant for extremely short-term revascularization therapies, which was previously limited to a relatively narrow time window for treatment with intravenous thrombolysis. Patients with in-hospital stroke may be more likely than patients with community-onset stroke to have contraindications to systemic thrombolysis because they may be recovering from surgery, experiencing systemic bleeding, admitted after major trauma, or have sundry other reasons. Contemporary hyperacute stroke care has shifted from a time-based focus to an emphasis on tissue-based assessment using neurovascular imaging to identify patients who may benefit from revascularization with thrombolysis or endovascular thrombectomy. It is therefore highly relevant to reexamine the quality of care and outcomes after short-term reperfusion treatment in patients with in-hospital stroke.