title: Predictors of hospital readmission 1 year after ischemic stroke.
abstract: Predictors of short-term readmission after ischemic stroke have been previously identified, but few studies analyzed predictors of long-term readmission, namely early imaging findings and treatment with intravenous thrombolysis (IVT). To characterize predictors of hospital readmission during the first year after hospitalization for ischemic stroke. The study consists of a retrospective cohort of consecutive ischemic stroke patients admitted in a Portuguese university hospital during 2013, who survived index hospitalization. We collected clinical and imaging information using the electronical clinical record. Information concerning 1-year unplanned hospital readmissions was assessed using the Portuguese electronic Health Data Platform. Descriptive and univariate analyses, Kaplan-Meier survival curve and multivariate survival analysis with Cox regression model were used. We included 480 patients, 50.6 % women, median age 79 years (interquartile range = 68-85). One-year hospital readmissions occurred in 165 patients [34.4 %, 95 % confidence interval (95 % CI) 30.2-38.7]. The main causes for readmission were infectious diseases (43.8 %), ischemic stroke or transient ischemic attack recurrence (13.2 %) and cardiac diseases (6.4 %). In-hospital mortality associated with readmission was 23.0 %. The independent predictors of 1-year hospital readmission after ischemic stroke were admission mini-National Institute of Health Stoke Scale [hazards ratio (HR) 1.05, 95 % CI 1.02-1.08, p = 0.002], and mild or absent early signs of ischemia on admission computed tomography (CT) (HR 0.54, 95 % CI 0.32-0.91, p = 0.021) and IVT (HR 0.11, 95 % CI 0.01-0.80, p = 0.029). Hospital readmission during the first year after ischemic stroke occurs in 1/3 of patients and is associated with high in-hospital mortality. Clinical stroke severity, early signs of ischemia on admission CT, and treatment with IVT are independent predictors of 1-year hospital readmission.
authors: Internal Medicine Department, Hospital Santa Maria Maior, Campo da República, 4754-909, Barcelos, Portugal.
authors: Alexandra
authors: A
authors: Leitão
authors: Internal Medicine Department, Hospital Conde de Bertiandos, Unidade Local de Saude do Alto Minho, Largo Conde de Bertiandos, 4990-041, Ponte de Lima, Portugal.
authors: Anabela
authors: A
authors: Brito
authors: Neurology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal. jdpinho@gmail.com.
authors: João
authors: J
authors: Pinho
authors: Neurology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal.
authors: José Nuno
authors: JN
authors: Alves
authors: Health Sciences School, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
authors: Ricardo
authors: R
authors: Costa
authors: Neuroradiology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal.
authors: José Manuel
authors: JM
authors: Amorim
authors: Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia, R. Dr. Francisco Sá Carneiro, 4400-129, Vila Nova de Gaia, Portugal.
authors: Manuel
authors: M
authors: Ribeiro
authors: Internal Medicine Department, Hospital Santa Maria Maior, Campo da República, 4754-909, Barcelos, Portugal.
authors: Inês
authors: I
authors: Pinho
authors: Neurology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal.
authors: Carla
authors: C
authors: Ferreira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology*; D013997:Time Factors
keywords: Ischemic stroke; Prognosis; Readmission; Thrombolysis