title: Recent trends in inpatient mortality and resource utilization for patients with stroke in the United States: 2005-2009.
abstract: BACKGROUND
  The aim of the study is to evaluate recent trends in mortality, length of stay, costs, and charges for patients admitted to the US hospitals with the principal diagnosis of stroke.
  
  
  METHODS
  This was a retrospective temporal trends study using data from the Nationwide Inpatient Sample from 2005 to 2009.
  
  
  RESULTS
  During the study period, there were 2.7 million hospital admissions with the diagnosis of stroke in the United States (470,000 intracerebral hemorrhage, 130,000 subarachnoid hemorrhage, and 2.1 million ischemic strokes). In-hospital mortality decreased from 10.2% in 2005 to 9.0% in 2009 (26.0%-23.0%, 23.4%-23.1%, and 6.0%-5.1% for the stroke subtypes, respectively), the average length of stay decreased from 6.3 days to 5.9 days (5.6-5.2 days for ischemic stroke, remained the same for hemorrhagic stroke), and the average number of 1.3 ± 0.1 procedures per admission remained the same. The proportion of patients with major or extreme severity of illness increased from 39.2% to 47.0% (P < .0001). After adjustment for inflation, the average total charge per admission increased from $36,215 to $46,518 (P < .0001), whereas the average cost of treatment remained the same. Higher treatment cost is associated with lower in-hospital mortality after adjustment for demographic, hospital-related, and clinical confounders (odds ratio = .968 [.965-.970] per each extra $1000).
  
  
  CONCLUSIONS
  Between 2005 and 2009, in-hospital mortality for patients hospitalized with stroke improved despite increasing severity of illness. At the same time, the average charge for hospitalization increased by 28% despite unchanged cost of treatment and shorter length of stay.
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia 22042, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Stepanova
authors.forename: Chapy
authors.initials: C
authors.lastname: Venkatesan
authors.forename: Laith
authors.initials: L
authors.lastname: Altaweel
authors.forename: Alita
authors.initials: A
authors.lastname: Mishra
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends*; D017722:Hospital Charges / Q000639:trends; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors; D014481:United States