Abstract TP3: Rate of Utilization and Determinants of Withdrawal of Care Among Acute Ischemic Stroke Patients Treated with Thrombolytics
Background: Our current practices for utilization of thrombolytics are based on the results of clinical trials with no or restricted use of “withdrawal of care” among treated patients. The increasing use of “withdrawal of care” in routine practice may lead to suboptimal outcomes among acute ischemic stroke patients treated with thrombolytics.
Objective: To identify the rate and determinants of “withdrawal of care” among acute ischemic stroke patients treated with thrombolytics in Nationwide Inpatient Survey (NIS) data files from 2002 to 2010.
Methods: We determined the frequency of “withdrawal of care” and compared the demographic, clinical characteristics, and in-hospital outcomes among thrombolytic treated ischemic stroke patients stratified by use of “withdrawal of care”.
Results: “Withdrawal of care” during hospitalization was instituted in 4327 (3.1%) of the 136854 acute ischemic stroke patients treated with thrombolytics. The mean age [±standard deviation] of the patients who underwent “withdrawal of care” was significantly higher (79±11.5 years versus 68±14.7, p<0.001). In the stepwise logistic regression, female sex (odds ratio [OR] 1.4, 95% confidence interval [1.1-1.7]), presence of atrial fibrillation (OR 2.1, 95% CI 1.8-2.5), and intracerebral hemorrhage (OR 3.2, 95% CI 2.5-4.1) were significant predictors of “withdrawal of care” among thrombolytic treated ischemic stroke patient. Large sized hospitals (OR 1.5, 95% CI 1.1-2.0), and teaching hospitals (OR 1.4, 95% CI 1.0-1.9) were more likely to use withdrawal of care. The rate of intubation and mechanical ventilation were significantly higher among patients who underwent “withdrawal of care”. In-hospital mortality (61% versus 8.6%, p=<0.0001) and the mean hospitalization charges ($84,072±79674 versus $69,104±75014, p<0.0001) were significantly higher among those with “withdrawal of care."
Conclusions: Our results identify several individual and institution related factors that determine the use of “withdrawal of care” among thrombolytic treated ischemic stroke patients. The excessively high mortality and resource utilization mandates a more evidence based policy for “withdrawal of care” in these patients.
- © 2012 by American Heart Association, Inc.