Does admission to hospital improve the outcome for stroke patients?

Objectives: to identify the factors associated with hospital admission and the differences in management and outcome of stroke patients between hospit al and home. Design: a prospective community stroke register (1995-8) with multiple noti fication sources. Setting: an inner city multi-ethnic population of 234 533 in South London, UK. Participants: 975 subjects with first in a lifetime strokes, whether or not they were admitted to hospital. Patients dying suddenly and those already hospitalized at the time of stroke were excluded. Main outcome Measures: factors associated with hospital admission; differen ces in management in the acute phase of stroke; mortality and dependency as sessed by the Barthel index 3 months post-stroke. Results: 812 patients were admitted to hospital for stroke; 163 were manage d in the community. Factors independently associated with hospital admissio n included stroke severity, pre-stroke independence, atrial fibrillation, h aving an intracranial haemorrhage and having a non-lacunar infarction. Comp uted tomography scan rates were higher in admitted (78%) than non-admitted patients (63%; P=0.001). By 3 months, 285 (35%) of the admitted patients ha d died compared with 13 (8%) of non-admitted patients (P<0.001). Of the adm itted patients, 241 (47%) had a Barthel index >18 compared with 106 (72%) o f those who were not admitted (P<0.001). After adjusting for case-mix varia bles, the odds ratios for death and dependency (Barthel index<18) in admitt ed and non-admitted patients were 2.21 (0.96-5.12) and 2.39 (1.35-4.22) res pectively. Conclusion: patients with clinical indicators for a more severe stroke were more likely to be admitted to hospital. Hospitalized stroke patients may h ave poorer survival and disability rates than those who remain at home, eve n after adjustment for case mix. There may be some aspects of acute hospita l care that may be detrimental to outcome in certain groups of stroke patie nts. This requires further investigation.