Introduction: Posterior circulation caries high mortality and morbidity compared to anterior circulation stroke. Till date there is no study that has compared this aspect across United States. We analyzed the treatement (intravenous tissue plasminogen activator[tPA],thrombectomy,either alone or in combination)received, discharge disposition and mortality of patients with posterior and anterior circulation stroke
Methods: 2008–2010 Nationwide Inpatient data sample was analysed. Figure1A gives the details of the variables used.Discharge-disposition, hospitalization-cost and mortality were the dependent variables that were studied. Univariate-analysis and multivariate-binary-logistic- regression analysis was done.
Results: Data for 1,311,511 patients admitted for acute-stroke were reviewed from the 2008–2010 NIS database. The mean age of these patients was 71.11 years(standard deviation14.7,Figure2). We analyzed data for the cohort of patients with acute stroke(anterior or posterior circulation)(n=55,913) who received some form of active intervention. 793/ 55913 patients had posterior circulation stroke, 436(55.0%) of which received tPA only, 194(24.5%)received thrombectomy+tPA and 163(20.6%) had only thrombectomies.
When overall outcome was considered, patients with posterior circulation stroke had a significantly higher number of OTR(Other-then-routine) discharge dispositions(p<0.0001) when compared to anterior circulation stroke. The mortality in posterior circulation was 35.9%(285) compared to 10.3%(5673) of anterior circulation(p<0.0001).
Posterior circulation stroke were preferentially treated at teaching hospitals 603(78.6%)
When compared to non teaching hospitals 164(21.4%).
Multivariate-regression analysis that included pertinent patient and hospital-factors showed that patients who had posterior circulation stroke had significant worse OTR (p<0.0001,OR1.618,CI 1.343–1.948).The mean hospitalization-cost for anterior circulation stroke was$71,977.34(SD$65466.97) and for posterior circulation $106365.59(SD$79857.70) , the difference was significant.
Conclusions: Our study showed that the Mortality and morbidity and cost incurred for the treatment of posterior circulation stroke is significantly higher than the anterior circulation stroke. And teaching hospitals are at the forefront of posterior circulation stroke management. The focus of research should be on the newer devices and drugs to augment best management.
Patient Care: Our research has shown the need to focus on the management of posterior circulation stroke by utilizing newer device/ drugs.
Learning Objectives: 1)The readers will understand the increased morbidity and mortality of posterior circulation stroke
2)The readers will understand the increased economic burden of posterior circulation stroke