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Does hospital
admission improve stroke outcome?
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Funded by:
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NHS Research and
Development 1999-2000
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Study
team:
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Dr Ajay Bhalla*
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Ms Ruth Dundas
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Dr Anthony Rudd
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Prof
Charles Wolfe
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Objective:
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To
identify the factors associated with hospital admission and the differences
in management and outcome of stroke patients between hospital and home.
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Setting:
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An
inner city multi-ethnic population of 234,533 in south London, UK,
comprising 975 participants who were first in a life time strokes -
admitted and non- admitted. Sudden deaths and patients already hospitalised
at the time of stroke were excluded.
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Design:
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A
prospective community stroke register (1995-1998) using multiple
notification sources. Factors associated with hospital admission.
Differences in management in the acute phase of stroke. Mortality and
dependency assessed by the Barthel Index at 3 months post stroke.
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Results:
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Factors
independently associated with hospital admission included stroke severity,
a Barthel Index of 20 prior to stroke, atrial fibrillation and suffering a
non-lacunar infarction. CT scan rates were higher in 632 (78%) admitted
patients compared with 102 (63%) non-admitted patients (P=0.001). After
adjusting for confounding factors, the odds ratios for death and dependency
(Barthel Index <20) in admitted patients compared with non-admitted
patients were 2.91 (1.06 to 7.97) and1.9 (1.09 to 3.29) respectively.
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Conclusions:
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Hospitalised
stroke patients have poorer survival and disability rates than those that
remain at home, even after adjustment for confounding factors. There may be
some aspects of acute hospital care that may be detrimental to outcome in
certain groups of stroke patients, which requires further investigation.
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References:
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Bhalla
A, Dundas R, Wolfe CDA, Rudd AG. Does admission to hospital improve the
outcome for stroke patients? Age and Ageing 2001; 30: 197-203
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