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Background: It remains unclear whether there is any improvement in outcomes of patients with intracerebral hemorrhage over the last decade. Objective: To determine trends pertaining in-hospital outcomes in patients with intracerebral hemorrhage using nationally representative data. Methods: We determined the national estimates of intracerebral hemorrhage admissions from 2005 to 2014 and associated in-hospital outcomes, length of stay, mortality, and cost incurred using the Nationwide Inpatient Survey (NIS) data. The NIS is the largest all-payer inpatient care database in the US and contains data from 986 hospitals approximating a 20% stratified sample of US hospitals. Outcome was classified as none to minimal disability, moderate to severe disability, and death based on discharge destination. Results: In the 10-year period, there were 70,637 admissions for intracerebral hemorrhage (annual estimate 80804 in 2005 to 109930 in 2014). There was a significant reduction in in-hospital mortality in patients with intracerebral hemorrhage from 30% to 23% (trend test, p < 0.0001). There was a trend towards increase in proportion of patients with moderate to severe disability (trend test, p < 0.097). The mean length of hospitalization increased from 8.58 days to 9.23 days (trend test, p < 0.0001) and cost of hospitalization increased from $50532.1 to $110932.1 (trend test, p < 0.0001). Conclusions: The mortality in patients with intracerebral hemorrhage has decreased but there is increased rates of moderate to severe disability, length of hospitalization, and hospitalization cost over the last decade.

Introduction/background: Do not resuscitate (DNR) orders have been associated with higher mortality in hospitalized patients which the question if they these patients are victims of the self-fulfilling prophecy; that the odds of their survival is made worse by withholding aggressive treatment. In addition, previous reports show that racial and ethnic minorities tend to opt for more aggressive and lifesaving procedures as compared to Whites. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. DNR code status was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, length of stay) were compared between the two groups. DNR code status was compared between different racial groups. Results: Of the 884379 patients with ICH, 81968 (9.26%%) had DNR order. ICH patients with DNR order had higher proportion of females (55.1% versus 49.1%, P <.0001) and were older (74.2 years versus 66 years, P <.0001) compared to ICH patients without DNR. The in-hospital mortality was also higher (53.4% versus 23.3%, p≤.0001) among patients with DNR both univariate and multivariate analysis (OR = 3.24 (3.07 -3.41), p<.0001) after adjusting for potential confounders. Whites have a higher rate (11.5% versus 8.08%) of DNR order as compared to other racial/ethnic groups Conclusions: While there may be other explanations at play, the higher mortality and shorter LOS suggest that early DNR orders do lead to the self-fulfilling prophecy. The lower proportion of DNR orders among minorities suggest a sociocultural aspect in accepting the concept of DNR. These two facts raise concerns about what the real vs perceived meaning of DNR orders.

Background: Avoidance of readmission is linked to improved quality of care, reduction in cost, and is a desirable patient-centered outcome. Nationally representative readmission metrics for patients with acute ischemic stroke treated with intravenous thrombolytic treatment (IV-tPA) are unavailable to date. Such estimates are necessary for benchmarking performance. Objectives: To identify US nationwide estimates and a temporal trend for 30-day hospital readmissions. Methods: We identified the cohort by year-wise analysis of the Nationwide Readmissions Database between January 1, 2010, and September 30, 2015. The database represents 50% of all US hospitalizations from 22 geographically dispersed states. Participants were adult (=>18 years) patients with a primary discharge diagnosis of acute ischemic (ICD-9-CM 433.x1 and 434.x1) who were treated with thrombolytic therapy (ICD-9-CM 9910). Readmission was defined as any admission within 30 days of index hospitalization discharge. Results: Based on study criteria, 57,676 eligible patients were included (mean [SE] age, 68.7 ± 14.4 years; 48.7% were women). Thirty-day readmission rate for acute ischemic stroke patients treated with IV-tPA was 11.17 % (95%CI, 10.92 %-11.43%). On average, there was a 4.4% annual decline in readmission between 2010 and 2014, which was statistically significant for the period of investigation (odds ratio, 0.95; 95%CI, 0.94-0.97). Age ≥ 65 years (OR 1.16 P <.0001), medical history of congestive heart failure (OR 1.11 P = 0.0056), chronic lung disease (OR 1.11 P = 0.0034) and renal failure (OR 1.35 P = <.0001) were independent predictors of readmission within 30 days. Conclusion: Nationally representative readmission metrics can be used to benchmark hospitals’ performance, and a temporal trend of 4.4 % may be used to evaluate the effectiveness of readmission reduction strategies.