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Abstract
Objective: Early mortality is a potential measure of the quality of care provided to hospitalized stroke patients. Whether in-hospital stroke mortality is reflective of deviations from evidence-based practices or patient/family preferences on life-sustaining measures is unclear.
Methods: All ischemic stroke mortalities at an academic medical center were reviewed to better understand the causes of inpatient stroke mortality.
Results: Among 37 deaths or discharges to hospice in 2009, 36 occurred after a patient/family decision to withdraw/withhold potentially life-sustaining interventions. An independent survey of 3 vascular neurologists revealed that some early deaths could have been delayed beyond 30 days if patients or families had agreed to more aggressive measures. From these data, we estimate the magnitude of a “withdrawal of care” bias to be approximately 40% of the observed short-term mortality.
Conclusions: Acute stroke mortality may be more reflective of patient/family preferences than the provision of evidence-based care.
GLOSSARY
- AHN=
- artificial hydration/nutrition;
- CMS=
- Center for Medicare and Medicaid Services;
- CPR=
- cardiopulmonary resuscitation;
- DNR=
- do not resuscitate;
- DVT=
- deep vein thrombosis;
- MV=
- mechanical ventilation;
- NIHSS=
- NIH Stroke Scale;
- SMH=
- Strong Memorial Hospital;
- tPA=
- tissue plasminogen activator;
- URMC=
- University of Rochester Medical Center
Footnotes
Study funding: This study was made possible in part by grant UL1 RR024160 from the National Center for Research Resources (NCRR), a component of the NIH, and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCRR or NIH.
Supplemental data at www.neurology.org
- Received November 23, 2011.
- Accepted March 21, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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