Pneumonia leads list of causes of hospital re-admissions after stroke

Stroke is a leading cause of hospital admission among older adults. Yet more hospital readmissions after stroke are for pneumonia or for heart disease than for another stroke, according to a study published in the June 2007 issue of the journal Stroke.

This finding may alter the standard medical management of post-stroke patients.

Few stroke patients survive five years without a readmission to the hospital. Common wisdom has been that patients who have had a stroke are likely to return to the hospital for treatment of another stroke. Our study found that, surprisingly, the most common reasons for readmission to the hospital were non-neurological, with pneumonia or other respiratory problem leading the list of reasons, said the study's first author, Dawn M. Bravata, M.D., Indiana University School of Medicine associate professor of medicine.

The researchers followed 2,603 stroke patients discharged from the hospital and found that more than half had died or been readmitted to a hospital at least once during the first year after discharge. And by five years out, almost 9 out of 10 stroke survivors had died or been readmitted to a hospital. These readmissions were more than twice as likely to be for pneumonia as for another stroke.

Physicians treating stroke patients need to continue focusing on preventing a recurrence of stroke. We now see that, in addition, we should also be thinking about the other conditions that are causing hospital readmission in this vulnerable group, she said.

Dr. Bravata, who is an investigator with the Center on Implementing Evidence-based Practice at the Roudebush VA Medical Center in Indianapolis, currently is working on a follow-up study to see whether certain interventions, such as pneumonia and influenza vaccinations, can lower hospital readmissions for stroke patients.

These readmissions are an enormous burden on patients, families and the health-care system. We may have a previously unrecognized window of opportunity beginning when the patient is first hospitalized for stroke to decrease the likelihood for hospital readmission, Dr. Bravata said.