title: Characteristics of in-hospital onset ischemic stroke.
abstract: OBJECTIVE
  The aim of the present study was to clarify the clinical characteristics of in-hospital onset stroke.
  
  
  METHODS
  We analyzed 15,815 patients with acute brain infarction registered in the Japan Multicenter Stroke Investigators' Collaboration (J-MUSIC) registry.
  
  
  RESULTS
  The in-hospital onset group included 694 (4.4%) patients and the out-of-hospital group included 15,121 (95.6%) patients. Atrial fibrillation (AF) was more common in the in-hospital onset group (34.6%) than in the out-of-hospital group (20.4%, p < 0.001). The admission NIHSS score (median, in-hospital 13 vs. out-of-hospital 5, p < 0.0001) and the mortality rate at discharge were higher in the in-hospital group than in the out-of-hospital group (in-hospital 19.2% vs. out-of-hospital 6.8%, p < 0.0001). On multivariate logistic regression analyses, female gender (OR 1.1, 95% CI 1.1-1.3), older age (OR 1.0, 95% CI 1.02-1.03), AF (OR 4.4, 95% CI 4.0-4.8), history of stroke (OR 1.3, 95% CI 1.2-1.4) and in-hospital stroke onset (OR 3.3, 95 %CI 2.7-3.9) were independent factors associated with severe stroke (NIHSS score > or =11), and older age (OR 1.03, 95% CI 1.02-1.04), the presence of AF (OR 1.21, 95% CI 1.0-1.5), in-hospital stroke onset (OR 1.01, 95% CI 1.01-1.02) and NIHSS score at initial evaluation (OR 1.15, 95% CI 1.14-1.17) were independent factors associated with death at discharge.
  
  
  CONCLUSIONS
  In-hospital stroke onset was not uncommon. The neurological deficits in patients with in-hospital onset stroke were severer and the outcome was worse than in those with out-of-hospital stroke. Therefore, a strategy to reduce in-hospital stroke onset should be implemented.
authors.affiliation: Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan. kimurak@med.kawasaki-m.ac.jp
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
authors.forename: Takenori
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology; D015996:Survival Rate