ED Treat-and-Release Visits for a Fall Linked to Higher Short-Term Stroke Risk

Emergency department (ED) treat-and-release visits for a fall are associated with a significantly increased short-term ischemic stroke risk, investigators reported in Stroke.

The case-crossover study evaluated administrative claims data from the Healthcare Cost and Utilization Project for all hospital admissions and ED visits in 10 US states from 2016 to 2020.

Participants were aged 18 years or older and hospitalized with an acute ischemic stroke. ED treat-and-release visits for a fall during the case periods (0-15, 16-30, 31-90, and 91-180 days before ischemic stroke) were compared with those during control periods (equivalent time periods 1 year before ischemic stroke). ED treat-and-release visits for a fall were identified with ICD-10 Clinical Modification codes.

The cohort included 90,592 adult patients with a hospitalization for acute ischemic stroke, of whom 6.8% had an ED visit for a fall within 180 days before their stroke, 5.8% had an ED treat-and-release visit, and 1% were not discharged home.

Participants who had a preceding ED treat-and-release visit for a fall were older (mean age, 74.7 [SD 14.6] vs 70.8 [SD 15.1] years), more frequently women (61.9% vs 53.4%) and White (76.7% vs 67.2%), and had increased vascular comorbidity rates compared with those without an ED treat-and-release visit for a fall during the preceding 180 days.

ED treat-and-release visits for a fall occurred significantly more frequently during the 15 days before an ischemic stroke compared with the 15-day control period 1 year earlier (odds ratio [OR], 2.69; 95% CI, 2.37-3.05). A significantly increased rate also occurred in the case periods of 16 to 30, 31 to 90, and 91 to 180 days. The association between an ischemic stroke and a preceding ED treat-and-release visit for a fall was reduced in magnitude with increasing temporal distance from ischemic stroke hospitalization, although it was still significant at 91 to 180 days.

ED treat-and-release visits for a fall were more common during the 15 days before an ischemic stroke for patients aged 65 years and older (OR, 2.82; 95% CI, 2.44-3.27) and those younger than 65 years (OR, 2.29; 95% CI, 1.77-2.98) with no significant difference (P_interaction =.35). ED treat-and-release visits for a fall also were increased during the 15 days before an ischemic stroke in men (OR, 2.69; 95% CI, 2.20-3.32) and women (OR, 2.68; 95% CI, 2.28-3.15; P_interaction =.97) and for White (OR, 2.66; 95% CI, 2.30-3.08) and non-White (OR, 2.77; 95% CI, 2.14-3.61) patients (P_interaction =.79).

The investigators noted that the patients were older in the case period vs the control period, and detailed information about diagnostic evaluation or prescribed medications was unavailable. Also, the study period includes the beginning of the COVID-19 pandemic, in which emergency care-seeking behaviors for stroke and falls changed.

“Some of these visits may represent opportunities to improve ED stroke diagnosis and treatment,” the researchers wrote.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor