title: Factors associated with length of hospitalization in patients admitted with transient ischemic attack in United States.
abstract: OBJECTIVE
  Approximately 70% of all patients presenting with transient ischemic attack are admitted to the hospital in United States. The duration and cost of hospitalization and associated factors are poorly understood. This article seeks to identify the proportion and determinants of prolonged hospitalization and to determine the impact on hospital charges using nationally representative data.
  
  
  METHODS
  We determined the national estimates of length of stay, mortality, and charges incurred in patients admitted with transient ischemic attack (diagnosis-related code 524 or 069) using Nationwide Inpatient Sample data from 2002 to 2010. Nationwide Inpatient Sample is the largest all-payer inpatient care database in the United States and contains data from ≈1000 hospitals, which is a 20% stratified sample of US community hospitals. All the variables pertaining to hospitalization were compared in 3 groups on the basis of length of hospital stay (≤ 1, 2-6, and ≥ 7 days).
  
  
  RESULTS
  A total of 949 558 patients were admitted with the diagnosis of transient ischemic attack during the study period. The length of hospitalization was ≤ 1, 2 to 6, and ≥ 7 days in 232 732 (24.4%), 662 909 (70%), and 53 917 (5.6%) patients, respectively. The mean hospitalization charges were $10 876, $17 187, and $38 200 for patients hospitalized for ≤ 1, 2 to 6, and ≥ 7 days, respectively. The use of thrombolytics (0.03%, 0.09%, and 0.1%; P<0.0001) for ischemic stroke was very low among the 3 strata defined by length of hospitalization. In the multivariate analysis, the following factors were associated with length of hospitalization of ≥ 2 days: age >65 years (odds ratio [OR], 1.5), women (OR, 1.2), admission to teaching hospitals (OR, 1.1), renal failure (OR, 1.7), hypertension (OR, 1.1), diabetes mellitus (OR, 1.2), chronic lung disease (OR, 1.4), congestive heart failure (OR, 1.4), atrial fibrillation (OR, 1.5), ischemic stroke occurrence (OR, 1.4), Medicare/Medicaid insurance (OR, 1.3), and hospital location in Northeast US region (OR, 1.5; all P values <0.025).
  
  
  CONCLUSIONS
  Approximately 75% of patients admitted with transient ischemic attack stay in the hospital for ≥ 2 days, with the most important determinants being pre-existing medical comorbidities. Longer duration of hospital stay is associated with 2- to 5-fold greater hospitalization charges.
authors: Zeenat Qureshi Stroke Research Center, University of Minnesota, 420 Delaware St SE, MMC 295, Minneapolis, MN 55455, USA. aiqureshi@hotmail.com
authors: Adnan I
authors: AI
authors: Qureshi
authors: Malik M
authors: MM
authors: Adil
authors: Haralabos
authors: H
authors: Zacharatos
authors: M Fareed K
authors: MF
authors: Suri
mesh_terms: D000368:Aged; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007348:Insurance, Health / Q000191:economics*; D002546:Ischemic Attack, Transient / Q000191:economics / Q000453:epidemiology*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Nationwide Inpatient Sample; hospital charges; hospital days; national estimate; thrombolytics; transient ischemic attack