OBJECTIVES: To assess factors influencing acute hospitalization for patients with first-ever ischemic stroke in Taiwan. METHODS: Data were prospectively collected from 360 first-ever ischemic stroke patients consecutively admitted to a medical center within 48 hours after symptom onset. Longer stay was defined as length of stay (LOS) >7 days after admission in department of neurology for acute care. The association between demographic characteristics or clinical variables and LOS was examined using multivariate logistic regression analysis. Discrimination of the model was assessed by the area under the receiver operating characteristic curve, and calibration was assessed using goodness of fit test. RESULTS: Patients (58% male) had mean age 64.9±12.7 (range, 18 to 93) years. Median National Institutes of Health Stroke Scale (NIHSS) score at admission was 6 (25th to 75th percentile, 3 to 12), median modified Barthel Index (MBI; on a scale of 0 to 20) at admission was 12 (25th to 75th percentile, 5 to 16). The LOS was >7 days in 169 (47%) patients. Male sex (odds ratio [OR], 1.7; 95% CI, 1.0 to 2.8), baseline NIHSS score 7-15 (versus 0-6) (OR, 2.9; 95% CI, 1.5 to 5.7), baseline NIHSS score ≥16 (versus 0-6) (OR, 3.1; 95% CI, 1.3 to 7.4), baseline MBI ≥12 (OR, 0.5; 95% CI, 0.3 to 1.0), and small vessel occlusive subtype (OR, 0.35; 95% CI, 0.2 to 0.6) were independent predictors of longer stay. Goodness-of-fit test (Hosmer-Lemeshow test) was not significant (P = 0.49), indicating adequate fitness. The model's discrimination was adequate with an under the curve area (receiver operating characteristic curve) of 0.776. CONCLUSIONS: The impact of stroke severity need to be understood to manager LOS. Early supported discharge planning would probably reduce the LOS in acute hospitalization of this group of first-ever ischemic stroke patients.