PATTERNS OF ACUTE HOSPITAL-CARE, REHABILITATION, AND DISCHARGE DISPOSITION AFTER ACUTE STROKE - THE PERTH-COMMUNITY-STROKE-STUDY 1989-1990

There have been few attempts to determine, for a defined population, the total number of patients admitted to hospital and requiring rehabilitation after acute stroke. In a population-based stroke register (the Perth Community Stroke Study) of 492 patients with acute stroke, 70% were admitted to hospital immediately after onset while another 10% were already in-patients for other reasons. The independent predictors of acute management outside hospital were residence in a nursing home [odds ratio (OR) 5.0, 95% confidence interval (CI) 1.8, 13.5], and age 85 years and over (OR 3.1; 95% CI 1.0, 9.0). The average length of stay in hospital was 32 days, (median 18, range 1-212 days), 23 days for acute beds and 55 days for rehabilitation beds. The in-hospital case fatality was 28% (95% CI 24%, 32%). Of the 302 patients discharged from hospital, 248 (82%) returned to their pre-morbid living arrangements. Failure to return home was related to the severity of the stroke (loss of consciousness and severe paresis) and social factors (living alone and pre-morbid disability). We estimate that patients with stroke, one third of whom are aged over 75 years, account for approximately 4% of the total acute bed capacity in metropolitan Perth. The data emphasise the need for hospital-based stroke services to be well organised and to have strong links with community services.