title: Why do ischemic stroke and transient ischemic attack patients get readmitted?
abstract: OBJECTIVE
  Readmission is an important indicator for the quality of healthcare services. The authors examined the reasons for 30-day readmission among urban stroke patients, and their clinical consequences.
  
  
  METHODS
  Consecutive patients admitted to a JCAHO certified primary stroke center with ischemic stroke or transient ischemic attacks (TIA) were included. Demographics, TOAST mechanism, risk factors, treatments administered and discharge destination were collected. Charts were reviewed for readmissions up to 30 days from discharge. Reasons for readmission and outcomes in terms of disability and discharge destination were determined.
  
  
  RESULTS
  Two hundred sixty-five patients (50.9% male; 79.6%African American; mean age 60.9 years) were included. There were 205(77.4%) strokes and 60(22.6%) TIAs. Thirteen (5%) patients died during their first admission. Of the remaining 252 patients, 25 (9.9%) were readmitted within 30 days. The reason for readmission was neurological in 8/25 patients (32%; 3 ischemic strokes, 1 hemorrhagic stroke and 4 TIAs); and non-neurological in 17/25 patients (68%). The frequent non-neurological reasons were infections (6/25), electrolyte disturbances (3/25) and trauma related to falls (2/25). Patients with coronary artery disease were more likely to be readmitted (45.5% vs. 14.7%; p=0.001) An NIH stroke scale ≥10 predicted readmission (50.0% vs. 25.4% for NIHSS<10; p value 0.02). Patients discharged home or to acute rehabilitation units were less likely to be readmitted than those discharged to subacute rehabilitation units or nursing homes (8.2% vs. 23.8%; p value=0.01).
  
  
  CONCLUSIONS
  Disabling strokes are more likely to be readmitted. The reason is often non-neurological, and sometimes preventable. Physicians should review cases that return within 30 days and determine best practices that prevent readmission.
authors.affiliation: Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, MI 48201, USA. pdbhatta@med.wayne.edu
authors.forename: Pratik
authors.initials: P
authors.lastname: Bhattacharya
authors.forename: Deependra
authors.initials: D
authors.lastname: Khanal
authors.forename: Ramesh
authors.initials: R
authors.lastname: Madhavan
authors.forename: Seemant
authors.initials: S
authors.lastname: Chaturvedi
mesh_terms: D000058:Accidental Falls / Q000401:mortality; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000401:mortality / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D006699:Home Care Services / Q000639:trends; D006801:Humans; D007239:Infections / Q000401:mortality; D007362:Intensive Care Units / Q000639:trends; D020300:Intracranial Hemorrhages / Q000401:mortality; D002546:Ischemic Attack, Transient / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D011787:Quality of Health Care / Q000639:trends*; D020521:Stroke / Q000401:mortality / Q000628:therapy*