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Comment & Response
December 2015

Treating In-Hospital Stroke

Author Affiliations
  • 1Wake Forest Baptist Medical Center, Winston Salem, North Carolina
  • 2University of Kentucky, Lexington
JAMA Neurol. 2015;72(12):1535. doi:10.1001/jamaneurol.2015.2663

To the Editor Saltman et al1 found delays in the evaluation and treatment of patients who had a stroke while hospitalized for another condition compared with those whose strokes occurred in the community. A “standardized approach to the recognition and management of in-hospital stroke” by developing “targeted code stroke protocols…similar to those used in the emergency department” was suggested.1 We previously reported the usefulness of such a protocol for hospitalized patients, comparing the yield of “stroke codes” between the in-hospital and emergency department (ED) settings in a single institution.2 We found that hospitalized patients for whom a stroke code was activated were less likely to have a stroke/transient ischemic attack (26.8% in-hospital vs 51.4% ED; P < .001) and less likely to be treated with intravenous tissue plasminogen activator (odds ratio, 0.27; 95% CI, 0.07-0.97; P = .03). Conditions not necessitating immediate neurologic care accounted for 63.4% of in-hospital stroke codes compared with 31.3% of those arising in the ED (P < .001). Altered mental status was the sole presenting symptom in 48% of the hospitalized patients compared with only 10% of ED patients (P < .001) and was independently associated with a stroke mimic (odds ratio, 63.52; 95% CI, 7.37-547.69; P < .001). There was no association between the diagnosis of an in-hospital stroke mimic and patient age, sex, race/ethnicity, or nursing shift.

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