Abstract W P336: Predictors of Outcome in Young Adults with Ischemic Stroke
Introduction: Approximately 10% - 22.5% of ischemic strokes are young adult strokes (YAS) (age 18-49 yr). We examined factors associated with home discharge and in-hospital mortality in YAS patients.
Methods: Using our institutional GWTG database, we analyzed 5,120 consecutive stroke inpatients (01/04 - 03/13). Univariate and multivariable models explored factors associated with in-hospital mortality and home discharge.
Results: YAS comprised 12% of the cohort (n=619). Compared to older adults, YAS patients were more often Hispanic and non-Caucasian. They presented with significantly fewer vascular risk factors and had a lower median NIHSS. Both groups received similar rates of stroke thrombolysis (IV or IA) and had similar adherence to early antithrombotics, dysphagia screening prior to oral intake, and DVT prophylaxis. YAS patients had lower in-hospital mortality (5% vs. 13%; p<0.001) and were more often discharged home (55% vs. 36%; p<0.001). Factors associated with in-hospital mortality in YAS patients were hypertension, CAD, higher NIHSS and in-hospital pneumonia. In multivariable models, only stroke severity at presentation predicted mortality (Table 1). YAS patients with increasing age, diabetes mellitus, higher NIHSS and in-hospital pneumonia were significantly less likely to be discharged home, while those receiving IV tPA were more likely to be sent home (Table 2).
Conclusion: Our data shows that despite differences in baseline profiles, YAS patients have similar factors predicting in-hospital mortality as that reported for all acute ischemic stroke patients. IV tPA use was associated with the favorable outcome of discharge home in our YAS cohort.
Author Disclosures: S.F. Ali: None. L.H. Schwamm: Consultant/Advisory Board; Modest; Joint Commission; MA Dept of Public Health. Other; Modest; AHA Get With the Guidelines (unpaid); Coverdell Registry Advisor (unpaid); MGH provides telehealth services under contract to hospitals in northern new england. Employment; Significant; Director, MassGeneral TeleHealth. A.B. Singhal: Expert Witness; Modest; Medical expert witness. Other; Modest; Chair, AAN Young Adult Stroke Awareness and Education Campaign.
- © 2014 by American Heart Association, Inc.