Healthcare News & Insights

Keys to recognizing, treating strokes in inpatients

Hospitals are known to have trouble recognizing heart attacks in inpatients who have been hospitalized for another illness. Now there’s another significant medical condition that’s proving tough for facilities to treat: stroke. 

ThinkstockPhotos-491144965According to new research, patients who have strokes in the hospital are more likely to have worse outcomes because of delayed treatment.

The study, published in the Journal of the American Medical Association Neurology, also showed that strokes in the hospital tend to be more severe, yet the symptoms often go unrecognized by clinicians.

Challenges for patients

Out of the patients examined by researchers who had strokes in the hospital, most were originally admitted to the hospital for surgery.

Compared to patients who had strokes outside the hospital, in-hospital stroke patients were more likely to have conditions like diabetes, hypertension, atrial fribrillation and high cholesterol. They were also older. Almost two-thirds of patients who had strokes in the hospital were over 65.

In-hospital stroke patients waited more than three hours longer for imaging tests (e.g., CT scans) to confirm their strokes than patients who had their strokes outside the hospital. And they were less likely to immediately receive treatment to dissolve blood clots that may have contributed to their stroke.

These delays hindered the recovery process. Patients who had strokes in the hospital had a higher degree of disability after their stroke, and had longer hospital stays.

Although recovery was slower, there was one bright spot: Fatality rates for patients who had in-hospital strokes were lower than the rates for other stroke patients after seven days. Both groups of stroke patients had similar death rates 30 days after their strokes, and the same trend showed for death rates a year after their strokes.

Using ‘code stroke’

Because the overall picture for stroke victims in the hospital is grim, hospitals need to improve their stroke-recognition process.

According to the study, up to 17% of acute strokes happen inside hospital walls. Even if these patients survive, they may be left with disabilities that negatively affect their quality of life for years. And in their weakened state, they may be more vulnerable to contract other illnesses that’ll land them in the hospital again.

One helpful idea proposed by researchers in the study: implementing a special “code stroke” protocol to better identify and treat strokes in hospital patients.

Doctors and nurses who don’t have a background in neurology may not immediately realize that a patient is having a stroke. So a key component of a code stroke program is training clinical staff to recognize the telltale signs of stroke in patients.

If a patient has any of the symptoms of a stroke, including weakness in the limbs, facial drooping and slurred speech, code stroke would be in effect. Staff would immediately follow a standardized stroke protocol and prepare the patient for a brain scan.

For hospitals that don’t have their own stroke alert protocol in place, the National Stroke Association has a checklist clinicians can use once a potential stroke is detected. Performing these steps within 30 minutes vastly improves a patient’s chances of recovery.

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