1. Hernandez Fustes, Otto J.
  2. Rodriguez, Carlos Arteaga

Article Content

Dear Editor:


We read with interest the article by Davis et al,1 and we would like to contribute with an interesting clinical finding, from a study of a cohort from the south of Brazil, which can highlight the discussion about the importance of hospitalization and stroke mortality factors.


Cerebrovascular disease (CVD) is the most common neurological pathology in hospital care and the first cause of disability in adults. In 2013, stroke was the second most common cause of deaths (11.8% of all deaths) worldwide, after ischemic heart disease, and the third most common cause of disability.2 The development of CVD units, associated with new imaging, therapeutic, and rehabilitation techniques, makes it possible to reduce the length of hospital stay and mortality of patients with acute CVD.


We performed a retrospective and descriptive study of patients hospitalized in a University Hospital in Curitiba, Brazil, for 4 years, to which the CVD program protocol was applied, and observed the ethical principles contained in the Resolution of the National Health Council n. 466 of December 12, 2012. We studied 1946 patients, 1038 male and 908 female. The largest number of patients was between 71 and 90 years old. The time of internment was 5 days in 830 patients (42.6%), among 6 to 10 days in 712 (36.6%), 11 to 15 days in 219 (11.3%), and more than 15 days in 185 cases (9.5%). CVD was the main cause of neurological hospitalization in our hospital.3


Hospital stay depends on multiple factors, including severity of the clinical picture, multidisciplinary treatment, carrying out complementary tests, complications, and social conditions. The implementation of specific services for the care of patients with CVD (stroke units) reduces the hospitalization time.4


Length of stay in patients with stroke could be related to many variables, including severity of the stroke, age, and comorbidities.5 Currently, the concern regarding the length of hospital stay is associated with delay in carrying out complementary examinations, infectious complications, expenses with professionals (multidisciplinary team), and hospital occupation. We observed that, in 5 to 6 days of hospitalization, we can perform all complementary examinations, confirm the diagnosis and the appropriate treatment, and demonstrate that, with the implementation of a multidisciplinary team, the length of stay and hospital expenses are reduced.


We agree with the results of Davis et al that support age, severity of stroke, and length of stay in the emergency room as predictors of hospital mortality for patients with intracerebral hemorrhage, as well as with suggestions to reduce morbidity and mortality for patients with intracerebral hemorrhage.1 In our experience, the factors affecting both cost and mortality are age, stroke subtype, other neurological disorders, renal failure, fluid and electrolyte disorders, and total number of comorbidities.6


We congratulate the authors for the excellent article and for the opportunity to delve into such an up-to-date and interesting topic.




1. Davis NW, Sheehan TO, Guo Y, Kelly DL, Horgas AL, Yoon SL. Factors associated with emergency department length of stay and in-hospital mortality in intracerebral hemorrhage patients. J Neurosci Nurs. 2021;53(2):92-98. doi: [Context Link]


2. Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120:439-448. doi: [Context Link]


3. Moreira A, Hernandez Fustes OJ, Arteaga Rodriguez C, Macarini L, Blanco A, Hinz AP. Doencas neurologicas mais frequentes no pronto socorro de um hospital universitario. Arq Neuropsiquiatr. 2000;58(S2):137. [Context Link]


4. Fang J, Alderman MH. Trend of stroke hospitalization. Stroke. 2001;32:2221-2226. [Context Link]


5. Van Straten A, van der Meulen JH, van den Bos GA, Limburg M. Length of hospital stay and discharge delays in stroke patients. Stroke. 1997;28:137-140. [Context Link]


6. Hernandez Fustes OJ, Arteaga Rodriguez C, Hernandez Fustes OJ. In-hospital mortality from cerebrovascular disease. Cureus. 2020;12(6):e8652. doi: [Context Link]