ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1683753
This article is part of the Research TopicQuality of Stroke Care: What Could Be Improved, and How? - Volume IIView all 20 articles
Predictors of Unplanned Hospital Readmissions and Emergency Department Revisits in Patients with Acute Ischemic Stroke
Provisionally accepted
Ammar Jumah*
Jennifer Ro
Tianwen MaJavacia OwensYunong WuDanielle StarnesHannah ChristopherDebra BlankeLaura Henriquez
Samir Belagaje
Nino KvantalianiJacquelyn CabralTeri WalczakJudy CollierKourtni Mack
Fadi Nahab- Emory University, Atlanta, United States
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Objectives: We aim to identify factors associated with emergency department (ED) revisits and hospital readmissions after acute ischemic stroke (AIS) diagnosis and to determine if early outpatient follow-up can reduce readmissions. Methods: We retrospectively identified all AIS patients discharged from a hospital network, from October1, 2022 to March 31, 2024. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with ED revisits and readmissions to the healthcare system within 90-days. Results: Of 1,973 patients, 464 (23.5%) had ED visits within 90 days and 263 (13.3%) had hospital readmission within 90 days. The median age was 68 [IQR 58, 77]. In multiple logistic regression analyses, factors independently associated with 90-day ED visit were history of heart failure (HF) (OR 1.46, 95% CI 1.11-1.93; p=0.007), diabetes mellitus (DM) (OR 1.41, 95% CI 1.12-1.77; p=0.003), atrial fibrillation (AF) (OR 1.47, 95% CI 1.13-1.92, p=0.004) and an increasing Charlson comorbidity index (CCI) score (OR 1.10, 95% CI 1.03-1.18), p=0.003). Factors associated with 90-day readmission were HF (OR 1.51, 95% CI 1.08-2.11, p=0.015), DM (OR 1.50, 95% CI 1.13-2.01, p=0.006), AF (OR 1.40, 95% CI 1.00-1.94, p=0.047) and increasing CCI score (OR 1.12, 95% CI 1.03-1.21, p=0.006). Discharge to inpatient rehabilitation or skilled nursing facility (versus home or home health) were associated with 90-day ED revisits and hospital readmissions. Patients who completed early (< 30 days) outpatient stroke clinic follow-up had a lower likelihood of 90-day readmission (OR 0.68, 95% CI 0.52-0.90; p=0.006). Conclusion: Patients with certain comorbidities including HF, DM, AF and those with a higher CCI score have a higher likelihood of a 90-day ED revisit and hospital readmission. Unplanned hospital readmissions may be preventable with early outpatient visits in a dedicated stroke clinic after discharge for AIS patients.
Keywords: Unplanned hospital revisits, Emergency department revisits, comorbidities, acuteischemic stroke, Telemedicine, prevention
Received: 11 Aug 2025; Accepted: 01 Oct 2025.
Copyright: © 2025 Jumah, Ro, Ma, Owens, Wu, Starnes, Christopher, Blanke, Henriquez, Belagaje, Kvantaliani, Cabral, Walczak, Collier, Mack and Nahab. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ammar Jumah, jumah.ammar@hotmail.com
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