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National trends in stroke and TIA care in U.S. emergency departments and inpatient hospitalizations (2006–2014)

  • Islam I. Bedaiwi
    Affiliations
    Department of Emergency Medicine, George Washington University, Washington, DC, USA

    Center for Healthcare Innovation & Policy Research, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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  • Sukayna Z. Alfaraj
    Affiliations
    Department of Emergency Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

    Center for Healthcare Innovation & Policy Research, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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  • Jesse M. Pines
    Correspondence
    Corresponding author at: 2100 Pennsylvania Ave. N.W Room 314, Washington, DC 20037, USA.
    Affiliations
    Department of Emergency Medicine, George Washington University, Washington, DC, USA

    Center for Healthcare Innovation & Policy Research, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Published:August 08, 2018DOI:https://doi.org/10.1016/j.ajem.2018.08.013

      Abstract

      Background

      We examine recent trends in U.S. emergency department (ED) and hospital care for stroke and transient ischemic attack (TIA).

      Method

      We used national ED and inpatient data from the Healthcare Cost and Utilization Project 2006–14. We explored trends in care and outcomes for patients treated in U.S. hospitals with stroke and TIA using descriptive statistics, as well as intracranial hemorrhage (ICH), a complication of stroke treatment.

      Results

      From 2006 to 14, there were 3.9 million U.S. ED visits with stroke and 2.5 million with TIA. Over the study, stroke visits grew 25% while TIA decreased 2%. Both conditions were more common among women and older adults, and most had Medicare insurance; however, Medicaid increased from 5.8% to 9.6% for stroke and 4.3% to 7.5% for TIA. Full inpatient hospitalizations fell for stroke from 89% to 83%, and TIA from 61% to 47%. Transfers from the ED for stroke & TIA increased from 4% to 8% and 2% to 5%, respectively. Inpatient mortality decreased for stroke & ICH and costs increased for all three conditions; however, length of stay (LOS) did not significantly change.

      Conclusion

      Over this nine-year study period, the average age of stroke & TIA patients was unchanged in U.S. hospitals; however, the proportion with Medicaid insurance increased considerably. Stroke incidence increased while TIA decreased slightly. Full inpatient hospitalizations are declining for both conditions, while transfers are on the rise. Average inpatient costs increased dramatically for all three conditions while mortality for stroke & ICH fell significantly.

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