Determinants of Neurological Outcome at Discharge and Length of Hospital Stay among Acute Ischemic Stroke Patients at Dr. H. Abdul Moeloek Regional General Hospital, Lampung Province, Indonesia
Abstract
Neurological status at discharge and length of hospital stay link the clinical quality of stroke care with its efficiency, yet evidence on the patient factors associated with these outcomes in Indonesian provincial referral hospitals remains limited. This study aimed to analyse the demographic and clinical factors associated with the National Institutes of Health Stroke Scale (NIHSS) score at discharge and the length of stay of patients with acute ischemic stroke. This retrospective cohort study used the medical records of all patients with acute ischemic stroke admitted to Dr. H. Abdul Moeloek Regional General Hospital, Lampung Province, between January 2022 and December 2025, selected by total sampling. Independent variables were age, sex, admission NIHSS score, and history of hypertension, diabetes mellitus, and atrial fibrillation. The outcomes were discharge NIHSS score (>5 vs 0–5) and length of stay (>5 vs 1–5 days), analysed using chi-square tests and risk ratios (RR) with 95% confidence intervals (CI). Of 989 patients, 355 (35.9%) were discharged with an NIHSS score >5 and 464 (46.9%) stayed longer than 5 days. A discharge NIHSS score >5 was associated with admission NIHSS >5 (RR 6.57; 95% CI 4.54–9.51), age ≥65 years (RR 1.64; 95% CI 1.16–2.31), atrial fibrillation (RR 1.60; 95% CI 1.30–1.98), and hypertension (RR 1.23; 95% CI 1.01–1.49). A length of stay >5 days was associated with admission NIHSS >5 (RR 1.99; 95% CI 1.67–2.38), age ≥65 years (RR 1.49; 95% CI 1.12–1.97), diabetes mellitus (RR 1.30; 95% CI 1.14–1.48), atrial fibrillation (RR 1.27; 95% CI 1.05–1.54), and hypertension (RR 1.18; 95% CI 1.01–1.37). Sex was not associated with either outcome. Initial stroke severity showed the strongest association with both outcomes, followed by older age, whereas diabetes mellitus was associated with prolonged stay but not with neurological outcome. Risk stratification based on admission NIHSS score and age may support discharge planning and bed management.
References
Abou-El-Hassan, H., Massoumi, S., Akhlaghi, S., Sarsour, R., Pillai, K., Petersen, M., Chang, E., Kuo, J., Nareddy, S., & Giraldo, E. A. (2025). High National Institutes of Health Stroke Scale scores, hyperglycemia, and anemia as predictors of length of stay in patients hospitalized for acute ischemic stroke. Cureus, 17(10), e94792. https://doi.org/10.7759/cureus.94792
Bustami, M., Idaiani, S., Putri, N. D., Satyagraha, A. W., Dewi Panjaitan, N. S., Ritonga, A. M., Mutiara Putri, A. N., Asyahida, S. R., Nurkhalizah, M. S., Nitisara, D. A., Rilianto, B., Susanto, N. H., Felistia, Y., & Santoso, A. (2025). Determinants of hospital length of stay in ischemic stroke patients: A retrospective cohort study at Indonesian national stroke center. PLOS One, 20(11), e0334355. https://doi.org/10.1371/journal.pone.0334355
Ding, G., Xu, J., He, J., & Nie, Z. (2022). Clinical scoring model based on age, NIHSS, and stroke-history predicts outcome 3 months after acute ischemic stroke. Frontiers in Neurology, 13, 935150. https://doi.org/10.3389/fneur.2022.935150
Donabedian, A. (2005). Evaluating the quality of medical care. The Milbank Quarterly, 83(4), 691–729. https://doi.org/10.1111/j.1468-0009.2005.00397.x
Feigin, V. L., Abate, M. D., Abate, Y. H., ElHafeez, S. A., Abd-Allah, F., Abdelalim, A., Abdelkader, A., Abdelmasseh, M., Abd-Elsalam, S., Abdi, P., Abdollahi, A., Abdoun, M., Abd-Rabu, R., Abdulah, D. M., Abdullahi, A., Abebe, M., Zuñiga, R. A. A., Abhilash, E. S., Abiodun, O. O., … Murray, C. J. L. (2024). Global, regional, and national burden of stroke and its risk factors, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology, 23(10), 973–1003. https://doi.org/10.1016/S1474-4422(24)00369-7
Feigin, V. L., Brainin, M., Norrving, B., Martins, S. O., Pandian, J., Lindsay, P., Grupper, M. F., & Rautalin, I. (2025). World Stroke Organization: Global stroke fact sheet 2025. International Journal of Stroke, 20(2), 132–144. https://doi.org/10.1177/17474930241308142
Kementerian Kesehatan Republik Indonesia. (2024, October 25). Cegah stroke dengan aktivitas fisik. Retrieved from: https://sehatnegeriku.kemkes.go.id/baca/umum/20241025/4046682/cegah-stroke-dengan-aktivitas-fisik
Lin, K.-H., Lin, H.-J., & Yeh, P.-S. (2022). Determinants of prolonged length of hospital stay in patients with severe acute ischemic stroke. Journal of Clinical Medicine, 11(12), 3457. https://doi.org/10.3390/jcm11123457
Miranda, L. A., Luvizutto, G. J., Bessornia, P. A. C., Furlan, N. E., Winckler, F. C., Ferreira, N. C., Hamamoto Filho, P. T., de Souza, J. T., Martin, L. C., Zanati Bazan, S. G., Pinheiro Modolo, G., de Freitas, C. C. M., Vidal, E. I. de O., & Bazan, R. (2024). To what extent does frailty mediate the association between age and the outcomes of brain reperfusion following acute ischemic stroke? Frontiers in Aging Neuroscience, 16, 1305803. https://doi.org/10.3389/fnagi.2024.1305803
Panthi, S., Sankhi, S., Bhandari, B., Paudel, S., & Marasine, N. R. (2025). Predictors of in-hospital mortality among stroke patients at a tertiary care hospital in Nepal: A prospective cohort study. Inquiry, 62. https://doi.org/10.1177/00469580251385397
Poll, M., Martins, R. T., Anschau, F., & Jotz, G. P. (2024). Length of hospitalization and mortality among stroke patients before and after the implementation of a specialized unit: A retrospective cohort study using real-world data from one reference hospital in Southern Brazil. Healthcare, 12(8), 836. https://doi.org/10.3390/healthcare12080836
Rexrode, K. M., Madsen, T. E., Yu, A. Y. X., Carcel, C., Lichtman, J. H., & Miller, E. C. (2022). The impact of sex and gender on stroke. Circulation Research, 130(4), 512–528. https://doi.org/10.1161/CIRCRESAHA.121.319915
Sherman, V., Greco, E., & Martino, R. (2021). The benefit of dysphagia screening in adult patients with stroke: A meta-analysis. Journal of the American Heart Association, 10(12), e018753. https://doi.org/10.1161/JAHA.120.018753
Watanabe, K., Okazaki, S., Kitano, T., Sugiyama, S., Ohara, M., Kanki, H., Sasaki, T., Sakaguchi, M., Mochizuki, H., & Todo, K. (2021). Stroke severity and outcomes in patients with newly diagnosed atrial fibrillation. Frontiers in Neurology, 12, 666491. https://doi.org/10.3389/fneur.2021.666491
Yadika, A. D. N., Saftarina, F., Zuraida, R., Sumekar, D. W., & Susianti, S. (2026). Determinan faktor-faktor yang memengaruhi kualitas hidup pasien stroke iskemik di RSUD dr. H. Abdul Moeloek Bandar Lampung [Determinants of factors affecting the quality of life of ischemic stroke patients at Dr. H. Abdul Moeloek Regional General Hospital, Bandar Lampung]. MAHESA: Malahayati Health Student Journal, 6(2), 443–460. https://doi.org/10.33024/mahesa.v6i2.24575
Yamanie, N., Felistia, Y., Susanto, N. H., Lamuri, A., Sjaaf, A. C., Miftahussurur, M., & Santoso, A. (2024). Prognostic model of in-hospital ischemic stroke mortality based on an electronic health record cohort in Indonesia. PLOS ONE, 19(6), e0305100. https://doi.org/10.1371/journal.pone.0305100
Copyright (c) 2026 International Journal of Science and Society
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
.png)
.jpg)
.png)
.png)
.png)
.png)
1.png)
.jpg)
-modified.png)
-modified.png)
-modified.png)
