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Predictors of hospital readmission 1 year after ischemic stroke

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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.

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Acknowledgments

Authors would like to thank Dr. Edgar Mesquita (School of Sciences, University of Minho) for helpful statistical advice.

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Authors and Affiliations

  1. Internal Medicine Department, Hospital Santa Maria Maior, Campo da República, 4754-909, Barcelos, Portugal

    Alexandra Leitão & Inês Pinho

  2. Internal Medicine Department, Hospital Conde de Bertiandos, Unidade Local de Saude do Alto Minho, Largo Conde de Bertiandos, 4990-041, Ponte de Lima, Portugal

    Anabela Brito

  3. Neurology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal

    João Pinho, José Nuno Alves & Carla Ferreira

  4. Health Sciences School, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal

    Ricardo Costa

  5. Neuroradiology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal

    José Manuel Amorim

  6. Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia, R. Dr. Francisco Sá Carneiro, 4400-129, Vila Nova de Gaia, Portugal

    Manuel Ribeiro

Authors
  1. Alexandra Leitão
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  2. Anabela Brito
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  3. João Pinho
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  4. José Nuno Alves
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  5. Ricardo Costa
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  6. José Manuel Amorim
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  7. Manuel Ribeiro
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  8. Inês Pinho
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  9. Carla Ferreira
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Correspondence to João Pinho.

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All procedures performed in studies involving human participants are in accordance with the ethical standards of the institutional or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Leitão, A., Brito, A., Pinho, J. et al. Predictors of hospital readmission 1 year after ischemic stroke. Intern Emerg Med 12, 63–68 (2017). https://doi.org/10.1007/s11739-016-1519-2

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  • DOI: https://doi.org/10.1007/s11739-016-1519-2

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