It is estimated that strokes occurring during hospitalization account for between four and seven percent of all acute strokes. This study was designed to better understand the care and outcomes of patients who sustain a stroke during hospitalization.

Data were obtained from the Ontario stroke registry database, with in-hospital strokes identified between July of 2003 and March of 2012. Those data were reviewed to determine the time from symptom onset to first neuronal imaging procedure. Secondary outcomes included time from stroke presentation to treatment and outcome of the stroke.

The study identified 29，810 patients with stroke, of whom 973 had in-hospital and 28，837 had community onset stroke. Compared to those with community identified strokes, patients with in-hospital strokes had longer times from symptom recognition to imaging (a median of 4.5 versus 1.2 hours, P<0.001). Those hospitalized at the time of stroke also had lower rates of thrombolysis，longer door to needle times, were less likely to be cared for in a stroke unit, and had lower rates of neuroimaging, carotid imaging, Holter monitoring, and swallowing assessment (P<0.001 for all comparisons). Patients with in-hospital stroke had a longer median length of stay, and were more likely to be disabled at discharge.

This study found that, compared with community onset stroke, patients with hospital onset stroke have longer delays before neuroimaging, are less likely to be cared for in a stroke unit and are more likely to be dead or disabled at discharge.