Understanding in-hospital stroke management and outcomes in the Australian stroke clinical registry (AUSCR).

Background and Purpose: The quality of care for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. Our aim was to compare patient characteristics, quality of care indicators, and outcomes for in-hospital strokes with those for community-onset strokes. Method(s): We used data from the Australia Clinical Stroke Registry (AuSCR) obtained from January 2010 to December 2013 (40 hospitals). Outcomes were compared using multilevel regression models and linked to the National Death Index. Utility scores were derived from the EQ-5D health-related quality-of-life (HRQoL) questionnaire assessed in eligible survivors at 90-180 days. Result(s): Among 13,860 registrants, 817 (6%) had the onset of symptoms whilst in hospital. Patients with an in-hospital stroke were more likely to be female (51% vs. 46%) and older (median age 78 vs. 76 years, p = 0.015) compared to community-onset cases. Fewer patients with an in-hospital stroke received stroke unit care (61% vs. 79%; p < 0.001).After accounting for patient and hospital characteristics, patients with in-hospital strokes were less likely to be discharged home (adjusted OR 0.31, 95% CI 0.25- 0.39) and more likely to die within 180 days from onset (aOR 2.02, 95% CI 1.69-2.43) or report worse HRQoL (mean difference utility score -0.11, 95% CI -0.16 to -0.06) compared with community-onset strokes. Conclusion(s): Compared to community-onset strokes, patients with an in-hospital stroke receive less stroke unit care and experience worse outcomes. These findings suggest an important opportunity for focused strategies to improve outcomes for patients who experience a stroke whilst in hospital.