Patients with acute stroke admitted on the second visit.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Nakajima
Makoto
M
Department of Medicine, Kumamoto Rosai Hospital, Yatsushiro, Japan. nakazima@fc.kuh.kumamoto-u.ac.jp
Hirano
Teruyuki
T
Uchino
Makoto
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003244:Consciousness Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data / Q000639:trends*; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D009325:Nausea / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D009460:Neurologic Examination / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D009462:Neurology / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D010291:Paresis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D010359:Patient Readmission / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D012008:Recurrence; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013038:Specialization; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult