1
|
Dsouza D, John SK, Nadig R, Bhardwaj S, Sarma G, Badachi S, Thomas K, Avati A, Shivde S, Mathew T. Inpatient Burden of Neurological Disorders: A Route Map for Allocation of Resources and Postgraduate Training. Cureus 2023; 15:e51311. [PMID: 38288171 PMCID: PMC10823301 DOI: 10.7759/cureus.51311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction There are limited data regarding the profile of inpatient neurological disorders in India. Understanding the spectrum of diseases and the profile of patients admitted in an inpatient setting will help to streamline services, allocate resources, develop management protocols, design curricula, and improve training programs of postgraduate students in neurology training. Objective The objective of this study is to study the profile of inpatient neurological disorders in 1000 consecutive patients admitted to a tertiary care neurological center. Methods Data from 1000 consecutive inpatients admitted to the Neurology Department at St. John's Medical College Hospital, Bengaluru from January 2018 to October 2018 were collected from the medical records. The data obtained from the case records were entered into a Microsoft Excel spreadsheet for descriptive analysis. Results The average age of the patients was 48 years (±18.18) and 606 of the 1000 patients were males. Strokes, including arterial and venous strokes, formed the major inpatient caseload, accounting for 48.7% of cases. Of these, 84% had ischemic arterial strokes, 7.4% had intracranial hemorrhage, and 8.4 % had cerebral sinus venous strokes; 19.3% of patients were admitted for seizures while 8.2% of patients were admitted for headache. Meningitis was diagnosed in 5.2% of patients; 4.8% of patients had central nervous system demyelinating and autoimmune diseases. A number of other diagnoses comprised less than 2.5% each and included movement disorders, peripheral nerve, spine and nerve roots disorders, neuromuscular diseases, neurodegenerative diseases, and medical and functional illness. Conclusion The most common disorders in the inpatient setting are stroke, seizure, headache, meningitis, and autoimmune/demyelinating disorders. These disorders should receive priority while planning the allocation of resources, educational curriculum, training, and teaching programs.
Collapse
Affiliation(s)
- Delon Dsouza
- Neurology and Stroke, Worcestershire Acute Hospitals NHS Trust, Worcester, GBR
| | - Saji K John
- Research, St. John's Medical College Hospital, Bengaluru, IND
| | | | - Shagun Bhardwaj
- Neuropsychology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Grk Sarma
- Neurology, St. John's Medical College Hospital, Bengaluru, IND
| | - Sagar Badachi
- Neurology, St. John's Medical College Hospital, Bengaluru, IND
| | - Kurian Thomas
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Amrutha Avati
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Sonia Shivde
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Thomas Mathew
- Neurology, St. John's Medical College Hospital, Bengaluru, IND
| |
Collapse
|
2
|
Amico F, Ashina S, Parascandolo E, Sharon R. Race, ethnicity, and other sociodemographic characteristics of patients with hospital admission for migraine in the United States. J Natl Med Assoc 2021; 113:671-679. [PMID: 34384595 DOI: 10.1016/j.jnma.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/11/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite the growing awareness across the general population, migraine is often underdiagnosed and undertreated in socially and economically marginalized groups. The present study aimed to investigate the differential effects of race and income on other sociodemographic data and hospital length of stay in patients admitted to hospital with a primary diagnosis of migraine headache. METHODS We utilized the Nationwide Inpatient Sample (NIS) database to identify patients admitted to the hospital from 2004 to 2017 with primary diagnosis of migraine. Information on demographic and length of stay data was obtained. Only patients older than 18 years were selected and age outliers were excluded. Race groups were identified as "White", "Black", "Asian or Pacific Islander", "Native American", or "Other ethnic group", as originally reported in the NIS database. Income was identified as the estimated median household income of residents in the patient's ZIP Code. RESULTS A total of 106,761,737 valid cases were identified. After applying our case inclusion criteria, only 61453 (median age= 42 years, range= 18-78 years) were included. Patients identified as "Black", "Hispanic" or "Native Americans" were more likely to have lower household income (p < 0.001), whereas higher income was found for the patients identified as "White"", even when men and women were considered separately (p < 0.001). No effects of race and/or household income was found on the length of stay in hospital. IMPLICATIONS The occurrence of migraine diagnosis on hospital admission in the USA can be impacted by dramatic culturally driven patient-clinician communication differences between ethnic groups.
Collapse
Affiliation(s)
- Francesco Amico
- Department of Psychiatry, Trinity Centre for Health Sciences, School of Medicine Trinity College Dublin, The University of Dublin, Dublin, Ireland.
| | - Sait Ashina
- BIDMC Comprehensive Headache Center, Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Roni Sharon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba - Tel HaShomer, Department of Neurology, Ramat Gan, Israel
| |
Collapse
|
3
|
Hospital Burden of Migraine in United States Adults: A 15-year National Inpatient Sample Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2790. [PMID: 32440450 PMCID: PMC7209847 DOI: 10.1097/gox.0000000000002790] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/26/2020] [Indexed: 10/26/2022]
Abstract
Background Migraine headache is associated with high costs, but changes over time of inpatient burden in the United States are unknown. Understanding longitudinal trends is necessary to determine the costs of evolving inpatient treatments that target biological factors in the generation of pain such as vasodilation and aberrant activity of trigeminal neurotransmitters. We report the migraine hospital burden trend in the United States over 15 years. Methods Data from the Nationwide Inpatient Sample of the Hospitalization Cost and Utilization Project databases were analyzed from 1997 to 2012. Inpatient costs were reported in dollars for the cost to the institution, whereas charges reflect the amount billed. These parameters were trended and the average annual percent change was calculated to illustrate year-to-year changes. Results Overall discharges for migraine headache reached a low of 30,761 discharges in 1999, and peaked in 2012 with 54,510 discharges. Average length of stay decreased from 3.5 days in 1997 to 2.8 days in 2012. Total inpatient charges increased from $176 million in 1999 to $1.2 billion in 2012. Inpatient costs totaled $322 million in 2012, with an average daily cost of $2,111. Conclusions Inpatient burden rapidly increased over the analyzed period, with hospital charges increasing from $5,939 per admission and $176 million nationwide in 1997, to $21,576 per admission and $1.2 billion nationwide in 2012. This trend provides context for research examining cost-effectiveness and quality of life benefits for current treatments. The study of these parameters together with better prevention and improved outpatient treatment may help alleviate the inpatient burden of migraine.
Collapse
|
4
|
Chua AL, Grosberg BM, Evans RW. Status Migrainosus in Children and Adults. Headache 2019; 59:1611-1623. [DOI: 10.1111/head.13676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Abigail L. Chua
- Hartford Healthcare Headache Center University of Connecticut School of Medicine West Hartford CT USA
| | - Brian M. Grosberg
- Hartford Healthcare Headache Center University of Connecticut School of Medicine West Hartford CT USA
| | | |
Collapse
|
5
|
Nyberg J, Gustavsson S, Linde M, Åberg ND, Rohmann JL, Åberg M, Kurth T, Waern M, Kuhn GH. Cardiovascular fitness and risk of migraine: a large, prospective population-based study of Swedish young adult men. BMJ Open 2019; 9:e029147. [PMID: 31473616 PMCID: PMC6719773 DOI: 10.1136/bmjopen-2019-029147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To examine the longitudinal relationship between cardiovascular fitness in young adult men and future risk of migraine and to estimate eventual differential effects among categories of body mass index (BMI) and blood pressure. DESIGN National, prospective, population-based cohort study. SETTING Sweden 1968-2014. PARTICIPANTS 18-year-old Swedish men (n=1 819 828) who underwent mandatory military conscription examinations during the years 1968-2005. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the first dispensation of prescribed migraine-specific medication, identified using the Swedish Prescribed Drug Register. The secondary outcome was documented migraine diagnosis from the Swedish National Hospital Register. RESULTS During follow-up, 22 533 men filled a prescription for migraine-specific medication. After confounding adjustment, compared with high cardiovascular fitness, low and medium fitness increased the risk of migraine-specific medication (risk ratio (RR)low: 1.29, 95% CI 1.24 to 1.35; population attributable fraction: 3.6%, 95% CI 1.7% to 5.3% and RRmedium: 1.15, 95% CI 1.12 to 1.19; population attributable fraction: 8.0%, 95% CI 4.0% to 11.7%). To assess potential effect measure modification, stratified analyses of these association by levels of BMI and blood pressure showed that lower fitness levels increased risk of migraine across all groups except among underweight men or men with high diastolic blood pressure. CONCLUSIONS Young men with a lower cardiovascular fitness had a higher long-term risk of developing pharmacological prescription-requiring migraine. This study contributes with information regarding risk factors for migraine in men, an understudied population in migraine research.
Collapse
Affiliation(s)
- Jenny Nyberg
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Neurology Clinic, Gothenburg, Sweden
| | - Sara Gustavsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology; Norwegian Advisory Unit on Headache, St Olavs University Hospital, Trondheim, Norway
| | - N David Åberg
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Internal Medicine, Gothenburg, Sweden
| | - Jessica L Rohmann
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Åberg
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan, Gothenburg, Sweden
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
| | - Georg Hans Kuhn
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Stroke Research and Neurocure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
6
|
Karri J, Abd-Elsayed A. Dihydroergotamine Infusion Therapy. INFUSION THERAPY 2019:95-105. [DOI: 10.1007/978-3-030-17478-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
7
|
The Effect of Propofol on Chronic Headaches in Patients Undergoing Endoscopy. Pain Res Manag 2018; 2018:6018404. [PMID: 29610631 PMCID: PMC5828566 DOI: 10.1155/2018/6018404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/30/2017] [Accepted: 11/02/2017] [Indexed: 11/28/2022]
Abstract
Objective This study determined acute and long-term effects of propofol administration in patients with severe headaches undergoing endoscopic procedures. Background Approximately 13% of the US population is affected by migraines or severe headaches. The effect of propofol on headaches more than a few days after the intervention has not been explored. Methods We employed a nonrandomized, prospective observational study that recruited patients with chronic headaches who received propofol from an outpatient endoscopy center for either upper or lower endoscopies. Patients completed the six-item Headache Impact Test (HIT-6) questionnaire prior to the procedure and 30 days after endoscopy. Additionally, the patients' response to propofol two days after endoscopy was assessed via phone. Results The age of the participants (n=31) ranged from 20 to 70 years. The mean HIT-6 composite scores were significantly lower (p < 0.05) 30 days after propofol administration when compared to baseline scores. Upon stratification, 23 patients indicated an improved condition, 7 a worsened outcome, and 1 showed no change. Furthermore, mean scores were significantly lower (p < 0.05) in three HIT-6 questions pertaining to the severity of pain, daily activity, and frequency of lying down. Finally, the mean pain score obtained was significantly lower (p < 0.05) two days after procedure. Conclusions The results of this suggest that propofol administration should be considered in treating chronic headaches. Double-blind studies are necessary to confirm these results.
Collapse
|