Date of Conferral

12-29-2025

Date of Award

December 2025

Degree

Ph.D.

School

Health Sciences

Advisor

David Segal

Abstract

Stroke is the second leading cause of mortality and the third leading cause of disability, affecting over 800,000 Americans annually. Traditional stroke research has focused on in-hospital settings, but not on prehospital stroke admissions, despite evidence that over 75% of acute stroke cases managed by emergency medical services involve prehospital hypertensive crises (HTN-C). HTN-C is classified into three systolic blood pressure (SBP) stages: Stage 1 (140–159 mm Hg), Stage 2 (160–179 mm Hg), and Stage 3 (≥180 mm Hg), the latter associated with organ damage. Hypertension correlates with longer hospital stays and more intensive interventions in hospitalized patients, but HTN-C alone is not associated with 30-day hospital readmissions. To date, there is no available research on the role of HTN-C and LOS on 30-day hospital readmissions in prehospital stroke cases while controlling for age, race, gender, and diabetes as a comorbidity. Secondary data consisting of 527 prehospital stroke cases from a Midwestern hospital between 2018 and 2022 were extracted from the Get with the Guideline Stroke database and predictors of 30-day hospital readmissions were analyzed using a binomial logistic regression model with SPSS v29. The study was guided by the patient-centered care model and Donabedian’s conceptual framework. The results indicated that length of stay (OR = 1.072, 95% CI [1.011, 1.136], p = .019) was a positive predictor of 30-day hospital readmissions when controlling for patient age (OR = 1.019, 95% CI [1.001, 1.037] whereas HTN-C was not significant. These findings may help inform modifications to traditional in-patient stroke care interventions based on predictors specific to prehospital stroke admissions and create positive social change.

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