ABSTRACT
BACKGROUND AND PURPOSE: Previous studies have suggested that patients suffering an in-hospital stroke (IHS) may face delays in treatment and worse outcomes compared to patients with community-onset strokes (COS). However, most studies occurred when intravenous thrombolysis was the primary treatment. This study aimed to examine the outcomes of patients experiencing an IHS in the endovascular thrombectomy (EVT) era. MATERIALS AND METHODS: Single-center retrospective cohort study of patients older than 18 years with acute ischemic stroke (AIS) treated with EVT within 12 hours of stroke onset from January 1, 2015, to April 30, 2021. Patients were classified into two groups: in-hospital strokes (IHS) and community-onset strokes (COS). We compared time metrics of stroke care delivery, rate of successful reperfusion, and functional outcome as scored using the modified Rankin Scale (mRS) score at 90 days (favorable outcome was defined as mRS 0-2). Differences in proportions were assessed using Fisher's exact and Chi-Square tests as appropriate. For continuous variables, differences in medians between groups were evaluated using Mann-Whitney U tests. RESULTS: A total of 676 consecutive patients were included, with 69 (10%) comprising the IHS group. IHS patients were more likely to have diabetes (36% vs. 18%, p=0.02) and less likely to receive thrombolysis (25% vs 68%, p<0.001) than the COS group but were otherwise similar. IHS patients had significantly faster overall time metrics, most notably from stroke recognition to imaging (median [IQR], 70 [38-141] min vs 121 [74-228] min, p<0.001). Successful recanalization was achieved in > 75% in both groups (p=0.39), with a median NIHSS at discharge <4 (p=0.18). The 90-day mRS was similar in both groups, with a trend of higher in-hospital mortality in the IHS group (p=0.06). CONCLUSIONS: IHS patients had shorter workflow delays to initiation of EVT compared to their community counterparts but with a similar rate of successful recanalization and clinical outcomes. Importantly, 90 day mortality and mRS scores were equivalent between IHS and COS. ABBREVIATIONS: AIS = acute ischemic stroke; LVO = large vessel occlusion; IHS= in-hospital stroke; COS= community-onset stroke; EVT= endovascular thrombectomy; CSC= comprehensive stroke center; TOAST= Trial of Org 10172 in Acute Stroke Treatment.
