title: Comparison of short-term outcomes of thrombolysis for in-hospital stroke and out-of-hospital stroke in United States.
abstract: OBJECTIVE
  In-hospital stroke (IHS) differs from out-of-hospital stroke (OHS) in risk factors and outcomes. We compared IHS and OHS treated with thrombolysis from a large national cohort in a cross-sectional study to further clarify these differences.
  
  
  METHODS
  The Nationwide Inpatient Sample for the years 2005-2010 was searched for adult acute ischemic stroke cases treated with intravenous or intra-arterial thrombolysis. Patients treated on the day of admission were classified as OHS. We compared the demographic and hospital characteristics, comorbidities, and short-term outcomes of thrombolysed IHS and OHS.
  
  
  RESULTS
  IHS included 8.7% of 11 750 thrombolysed stroke cases in this study. IHS was associated with a higher comorbidity profile and higher rates of acute medical conditions compared with OHS. IHS had higher inpatient mortality (15.7% versus 9.6%; P<0.001) and lower rate of discharge to home/self-care (22.8% versus 30.0%; P<0.001). IHS was also associated with higher mortality among endovascular treatment group (19.3% versus 13.8%; P=0.010). The difference in the rate of all intracerebral hemorrhage was not significant (5.3% versus 4.7%; P=0.361). In the multivariate analysis, inpatient mortality (adjusted odds ratio, 1.59; 95% confidence interval, 1.32-1.92; P<0.001) and favorable discharge outcome (adjusted odds ratio, 0.79; 95% confidence interval, 0.67-0.93; P=0.005) remained significantly worse in IHS.
  
  
  CONCLUSIONS
  Thrombolysed IHS is associated with worse discharge outcomes compared with thrombolysed OHS, likely because of their higher comorbidities and additional medical reasons for the index admission. Thrombolysis is not associated with a higher rate of intracerebral hemorrhage among IHS.
authors: Department of Neurology, Stroke Center, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA. Yogesh.Moradiya@Downstate.edu
authors: Yogesh
authors: Y
authors: Moradiya
authors: Steven R
authors: SR
authors: Levine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016270:United States Agency for Healthcare Research and Quality; D055815:Young Adult
keywords: Nationwide Inpatient Sample; in-hospital stroke; intracerebral hemorrhage; ischemic stroke; thrombolysis
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