Impact of intravenous thrombolysis on length of hospital stay in cases of acute ischemic stroke
Received 16 September 2017
Accepted for publication 5 December 2017
Published 9 January 2018 Volume 2018:14 Pages 259—264
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Wai Kwong Tang
Narongrit Kasemsap,1,2 Nisa Vorasoot,1,2 Kannikar Kongbunkiat,1,2 Udomlack Peansukwech,1 Somsak Tiamkao,1,2 Kittisak Sawanyawisuth1,3,4
1Department of Medicine, Faculty of Medicine, 2North-Eastern Stroke Research Group, 3Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), 4Internal Medicine Research Group, Khon Kaen University, Khon Kaen, Thailand
Background: There are limited data available on factors associated with length of stay (LOS) in cases of acute ischemic stroke according to Poisson analysis, which is more appropriate than other methods.
Materials and methods: We retrospectively reviewed medical summary charts of patients with acute ischemic stroke in 30 hospitals across northeast Thailand, with the main outcome as LOS. Poisson regression was used to examine factors associated with LOS.
Results: We included 898 patients in the analysis; 460 (51.2%) were male. The median age (interquartile; IQR) was 58 (67–75) years and the median LOS was 5 (4–7) days. The median National Institute of Health Stroke Scale (NIHSS [IQR]) was 8 (4–13). Results of the analysis showed that, after controlling for age, stroke severity, atrial fibrillation, and thrombolytic use, significant variables associated with LOS were moderate stroke (incidence rate ratio [IRR] 95% confidence interval [CI] =1.15 [range 1.01–1.30], P=0.040), severe stroke (IRR [95% CI] =1.27 [1.09–1.47], P=0.002), thrombolytic use (IRR [95% CI] =0.68 [0.60–0.76], P<0.001), and atrial fibrillation (IRR [95% CI] =1.15 [1.02–1.30], P=0.023). After adjusting for complications, thrombolytic use remained significantly associated with decreased LOS (IRR [95% CI] =0.74 [0.67–0.83], P=0.001). Other significant factors were atrial fibrillation (IRR [95% CI] =1.14 [1.02–1.28], P=0.018), pneumonia (IRR [95% CI] =1.48 [1.30–1.68], P<0.001), and urinary tract infection (IRR [95% CI] =1.41 [1.14–1.74], P=0.001).
Conclusion: According to Poisson analysis, intravenous thrombolysis, atrial fibrillation, pneumonia, and urinary tract infection are associated with LOS in cases of acute ischemic stroke, regardless of age, stroke severity, comorbidities, or complications.
Keywords: acute ischemic stroke, length of stay, thrombolysis
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