At the first sign of a stroke, time is of the essence. For every minute of delay in treatment, people typically lose almost two million brain cells. Yet a new study presented at the Canadian Stroke Congress reveals that those delays -- in getting the right tests and the right drugs -- can be longer when people experience a stroke in a hospital.
Investigators from the University of Toronto Faculty of Medicine, the Institute for Clinical Evaluative Sciences (ICES) and the University Health Network looked at data from acute care facilities in Ontario over nine years. They examined stroke care delivery and outcomes for two groups: those who had a stroke in the community (about 32,000 people), and those who had a stroke while already hospitalized for another reason (just over 1,000 cases), such as, for example, a hip replacement. The results were surprising.
"Intuitively, you would imagine that having a stroke in the hospital is the best place possible, and that is just not the case," says Dr. Alexandra Saltman, a third year internal medicine resident at the University of Toronto, and one of the authors of the Code Stroke on the Ward study.
Compared to the patients brought into a hospital from the community, people with in-hospital strokes:
The study's authors made the comparisons using the Heart and Stroke Foundation's Canadian Stroke Best Practice Recommendations and the American Heart Association best practice guidelines for stroke care. After adjusting for age and other factors, the in-hospital stroke patients also had longer hospital stays and were more likely to be disabled.
"There is evidence that people do worse when they have a stroke in the hospital, and not just because they are already sicker," says Dr. Saltman.
She suggests two possibilities for what seems to be a lag in response, despite the fact that the patient is surrounded by health-care professionals.
First, the signs of a stroke are too often overlooked. When patients are admitted for other medical reasons (for example, heart surgery or pneumonia), hospital staff on that ward are understandably focused on that ailment or condition, and are not specifically looking for stroke symptoms.
"We're all human, and things get missed," says Dr. Saltman. "In a medically or surgically complicated patient, it may be harder to detect the stroke symptoms than in someone with no other acute issues."
This is an important reminder for hospitals to promote awareness of stroke. "Awareness of stroke signs and how to react is important for all health care professionals, in any specialty," says Patrice Lindsay, director of stroke best practices and performance for the Heart and Stroke Foundation. "The reality is that people can have a stroke in hospital regardless of why they are hospitalized."
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Stroke outcomes can be worse when they occur in hospital