In his editorial, Dr. Dulli notes that in-hospital stroke is a “large problem,” representing between 4 and 17 percent of all acute stroke, with “unique challenges.” In the current study, “Nearly half the in-hospital strokes occurred on surgical services, and perhaps for many of them a perioperative contraindication to thrombolytic therapy was the basis for not using code stroke. More of the patients with in-hospital stroke were drowsy or moribund due to their admitting illnesses and medications for these. In such situations both the time of symptom onset and contribution to patients’ overall deficits may have been felt to be too obscure; no code stroke was felt to be warranted,” he points out.

“Whatever the reasons for this delay, these studies reveal a paradox in which a critical therapy is limited or delayed in a group of patients whose need for it may be greater,” Dr. Dulli writes.

Recognition of in-hospital stroke is a “major problem,” he said in the JAMA Neurology podcast. “The most striking outcome” in this study was the delay in symptom recognition and neuroimaging.

“It’s clear that there needs to be more of a protocol-driven approach to in-hospital stroke both in terms of recognition and what to do when stroke is recognized or suspected,” he said.

The Canadian Stroke Network supported this study.