Cardiac Point-of-Care Ultrasound Performed in a Stroke Unit Is Associated with a Reduced Hospital Length of Stay

TL;DR

Using cardiac point-of-care ultrasound in stroke units is linked to shorter hospital stays for patients with acute ischemic stroke.

Contribution

This study shows that neurologist-performed cardiac point-of-care ultrasound reduces hospital length of stay in stroke patients.

Findings

Patients who had cPOCUS had a shorter median hospital stay compared to those who only had TTE.

After adjusting for confounders, cPOCUS remained independently associated with reduced length of stay.

cPOCUS may improve hospital workflows and could be integrated into routine stroke care.

Abstract

Objectives: Cardiac point-of-care ultrasound (cPOCUS) enables rapid bedside cardiac assessment and may facilitate early identification of potential cardiac sources of embolism in patients with acute ischemic stroke (AIS). This study aimed to evaluate whether neurologist-performed cPOCUS is associated with reduced hospital length of stay (LOS) in patients admitted to a Stroke Unit (SU). Methods: We conducted a retrospective observational study including consecutive patients with AIS admitted between 2020 and 2021 who required cardiac ultrasound for etiological evaluation. Patients underwent cPOCUS and/or transthoracic echocardiography (TTE) and were classified into two groups: those evaluated with cPOCUS (with or without TTE) and those evaluated exclusively with TTE (control group). The availability of cPOCUS depended on predefined weekly schedules rather than individual clinical decision-making, partially mitigating selection bias. The primary outcome was LOS. Multivariable linear regression analysis was performed to adjust for potential confounders. Results: Among 808 patients with AIS, 332 underwent cardiac ultrasonography during hospitalization: 219 in the cPOCUS group and 113 in the control group. Overall, 60.4% were male, the mean age was 68.4 years (SD 13.3), and the median National Institutes of Health Stroke Scale score at admission was 5 (IQR 9), with no significant differences between groups. Median LOS was shorter in the cPOCUS group than in the control group [7 days (IQR 4) vs. 8 days (IQR 5); p = 0.015]. After adjustment for confounders, cPOCUS evaluation remained independently associated with shorter LOS (β −1.49, standard error 0.73, 95% CI −2.93 to −0.05; p = 0.04). Conclusions: Neurologist-performed cPOCUS is independently associated with reduced LOS in patients with AIS admitted to an SU. These findings suggest that cPOCUS may facilitate more efficient in-hospital workflows and support its potential integration into routine stroke care pathways.

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