In-Hospital Stroke Still Linked to Worse Outcomes Despite Increased Use of Mechanical Thrombectomy
KEY TAKEAWAYS
- In-hospital stroke was associated with higher mortality and worse functional outcomes than community-onset stroke.
- Mechanical thrombectomy use increased significantly between 2016 and 2023 in both groups.
- Recognition-to-CT time was longer for in-hospital stroke than for community-onset stroke.
In a retrospective cohort study of Get With The Guidelines–Stroke registry data, patients who experienced in-hospital stroke continued to have worse outcomes than those with community-onset ischemic stroke, despite improvements in stroke quality metrics and increased use of mechanical thrombectomy (MT).
Researchers analyzed 4,996,392 ischemic stroke admissions in the Get With The Guidelines–Stroke registry from 2016 to 2023. Among these, 191,355 (3.8%) were in-hospital strokes, and 4,805,037 (96.2%) were community-onset strokes. The primary outcomes were in-hospital mortality, discharge home, and independent ambulation at discharge.
What the Data Showed
- Severe stroke (National Institutes of Health Stroke Scale score >20) occurred in 14.5% of in-hospital strokes versus 7.9% of community-onset strokes.
- Median recognition-to-CT time was 51 minutes for in-hospital stroke compared with 18 minutes for community-onset stroke (P<.001).
- In-hospital stroke was associated with higher in-hospital mortality (adjusted odds ratio [aOR], 2.27; 95% CI, 2.18-2.36).
- Patients with in-hospital stroke were less likely to be discharged home (aOR, 0.46; 95% CI, 0.45-0.48) or ambulate independently at discharge (aOR, 0.52; 95% CI, 0.50-0.53).
- MT utilization increased from 4.47% to 9.54% among patients with in-hospital stroke and from 2.35% to 5.55% among those with community-onset stroke between 2016 and 2023 (P<.001 for trend).
In a secondary analysis comparing earlier registry data with data from the era of MT, stroke quality measures and outcomes improved among patients with in-hospital stroke, independent of treatment modality. However, the authors concluded that greater stroke severity and poorer outcomes persist among people with in-hospital stroke, highlighting ongoing gaps in timely recognition and imaging for hospitalized patients with stroke.
Source
Nouh A, Olson D, Liang H, et al. In-hospital stroke quality and outcomes in the mechanical thrombectomy era: Get With The Guidelines-Stroke, 2016 to 2023. Stroke. Published online 2025. doi:10.1161/STROKEAHA.125.054993.