Table of Contents
ISRN Stroke
Volume 2013, Article ID 312348, 5 pages
Clinical Study

Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay

1Stroke Program at Tulane University Hospital, Department of Neurology, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA
2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL 35294-0022, USA
3Department of Neurology, School of Medicine, University of Alabama at Birmingham, 1670 University Blvd., Birmingham, AL 35233-0022, USA
4Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), 1530 3rd Avenue South, Medical Towers, Birmingham, AL 35294-4410, USA
5Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), Medical Towers Building, 1717 11th Avenue South, Suite 516A, Birmingham, AL 35294-4410, USA
6Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL 35294-0022, USA

Received 27 June 2013; Accepted 14 August 2013

Academic Editors: J. Mocco, C. White, and C. Zweifel

Copyright © 2013 Alexander J. George et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Prolonged length of stay (pLOS) following ischemic stroke inflates cost, increases risk for hospital-acquired complications, and has been associated with worse prognosis. Methods. Acute ischemic stroke patients admitted between July 2008 and December 2010 were retrospectively analyzed for pLOS, defined as a patient stable for discharge hospitalized for an additional ≥24 hours. Results. Of 274 patients included, 106 (38.7%) had pLOS (median age 65 years, 60.6% female, 69.0% black). Patients with pLOS had higher admission NIHSS than patients without pLOS (9 versus 5, ). A larger proportion of patients with pLOS developed an infection ( ), and after adjusting for covariates, these patients had greater odds of poor short-term functional outcome (OR = 2.25, 95% CI 1.17–4.32, ). Adjusting for infection, the odds of patients with pLOS having poor short-term functional outcome were no longer significant (OR = 1.68, 95% CI 0.83–3.35, ). Conclusions. The contraction of a hospital-acquired infection was a significant predictor of pLOS and a contributor of poor short-term outcome following an ischemic stroke. Whether the cause or the consequence of pLOS, hospital-acquired infections are largely preventable and a target for reducing length of stay.