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Qiu K, Xie T, Wei K, Shi HB, Liu S. Validation of the prehospital stroke scales as a tool for in-hospital large vessel occlusion stroke: whether we satisfied? Acta Neurol Belg 2024; 124:467-474. [PMID: 37889423 DOI: 10.1007/s13760-023-02402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Prehospital stroke severity scales have been widely used to identify whether community stroke patients presented with large vessel occlusion (LVO) or not. However, whether these scales are also applicable to in-hospital stroke patients remains unknown. PURPOSE We aim to validate and compare the predictive capability of these scales for these patients. MATERIAL AND METHODS From January 2016 to October 2020, a total of 243 patients who activated in-hospital stroke alerts, were included in this study. The area under the curve (AUC) was used to assess the predictive ability of five scales (Field Assessment Stroke Triage for Emergency Destination [FAST-ED], Rapid Arterial Occlusion Evaluation [RACE], Los Angeles Motor Scale [LAMS], Cincinnati Prehospital Stroke Severity Scale [CPSSS], and Prehospital Acute Stroke Severity scale [PASS]) for LVO. In addition, multivariable logistic analysis was adopted to determine the predictors of LVO in our patients cohort. RESULTS Finally, 94 (38.7%) patients were confirmed presence of persistent LVO. The AUC for the FAST-ED, RACE, LAMS, CPSSS, and PASS scales to predict the presence of LVO in patients activating in-hospital stroke alerts were 0.82, 0.89, 0.86, 0.81, and 0.79, respectively. After multivariable analysis, baseline NIHSS (adjusted odds ratio [OR] = 1.160, 95% confidence interval [CI] = 1.110-1.212; P < 0.001) atrial fibrillation (adjusted OR = 2.940, 95% CI = 1.387-6.230; P = 0.005) and cardiac/pulmonary procedure (adjusted OR = 6.861, 95% CI = 2.437-19.315; P < 0.001) remained independent predictors of LVO. CONCLUSION The prehospital stroke scales also showed good predictive capabilities in discriminating LVO among inpatients who activated stroke alerts. However, given that inpatients' history is more readily available, a specifically designed in-hospital stroke scale that combines stroke severity and history is warranted.
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Affiliation(s)
- Kai Qiu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Ting Xie
- Department of Radiology, Women's Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Ke Wei
- Department of Stroke Center, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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Yei KS, Cui CL, Ramachandran M, Malas MB, Al-Nouri O. Effect of Postoperative Stroke Timing on Perioperative Mortality After Carotid Revascularization. Ann Vasc Surg 2022; 92:124-130. [PMID: 36584965 DOI: 10.1016/j.avsg.2022.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND In-hospital stroke (IHS) has been associated with worse outcomes than out-of-hospital stroke (OHS) due to delays in diagnosis and treatment. A paucity of studies exists comparing the timing of postoperative stroke after carotid revascularization. We aimed to study the effect of IHS versus OHS on postoperative mortality in carotid revascularization patients in a large-scale national database. METHODS This is a retrospective cohort study of patients who underwent carotid artery stenting (CAS) and carotid endarterectomy (CEA) between 2011 and 2018 in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Statistical analysis included chi-squared test and multivariable logistic regression. Patients were divided based on postoperative stroke timing (no stroke, IHS, or OHS) as well as procedure type (CEA or CAS). RESULTS A total of 31,304 carotid revascularizations were performed with 420 (1.3%) IHSs and 207 (0.7%) OHSs. On adjusted analysis, there was significantly higher perioperative mortality with both IHS [odds ratio (OR): 19.75, 95% confidence interval (CI): 13.61-28.18, P < 0.001] and OHS [OR: 29.73, 95% CI: 18.76-45.82, P < 0.001]. There was no difference in mortality after OHS versus IHS [OR: 1.51, 95% CI: 0.89-2.55, P = 0.161]. CONCLUSIONS Any postoperative stroke after carotid revascularization significantly increased the odds of 30-day mortality. In contrast to previous studies demonstrating worse outcomes after IHS than OHS, we observed similar 30-day mortality between the 2 stroke categories. Improved follow-up and early recognition with rescue within carotid revascularization patients compared to the general population could potentially contribute to these results. However, overall mortality remains high for any postoperative stroke following carotid revascularization, emphasizing the importance of vigilant in-hospital monitoring and follow-up even after discharging the patient.
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Affiliation(s)
- Kevin S Yei
- Department of Surgery, Division of Vascular Surgery, UC San Diego, San Diego, CA
| | - Christina L Cui
- Department of Surgery, Division of Vascular Surgery, UC San Diego, San Diego, CA
| | | | - Mahmoud B Malas
- Department of Surgery, Division of Vascular Surgery, UC San Diego, San Diego, CA
| | - Omar Al-Nouri
- Department of Surgery, Division of Vascular Surgery, UC San Diego, San Diego, CA.
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3
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The Influence of Periodontal Diseases and the Stimulation of Saliva Secretion on the Course of the Acute Phase of Ischemic Stroke. J Clin Med 2022; 11:jcm11154321. [PMID: 35893412 PMCID: PMC9329893 DOI: 10.3390/jcm11154321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/14/2022] [Accepted: 07/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background and purpose: The course of an ischemic stroke depends on many factors. The influence of periodontal diseases and the stimulation of salivation on the course and severity of stroke remains unresolved. Therefore, the aim of the study was to analyze the severity of ischemic stroke depending on the occurrence of periodontal diseases and saliva stimulation. Methods: The severity of the neurological condition was assessed using the NIHSS scale on days one, three and seven of stroke. The incidence of periodontal diseases was classified using the Hall’s scale in the first day of stroke. On days one and seven of stroke, the concentration of IL-1β, MMP-8, OPG and RANKL in the patients’ saliva was assessed using the Elisa technique. At the same time, the level of CRP and the number of leukocytes in the peripheral blood were tested on days one, three and seven of the stroke, and the incidence of upper respiratory and urinary tract infections was assessed. Results:100 consecutive patients with their first ever ischemic stroke were enrolled in the study. 56 randomly selected patients were subjected to the stimulation of salivation, the remaining patients were not stimulated. In the study of the severity of the neurological condition using the NIHS scale on days three and seven of stroke, the degree of deficit in patients without periodontal disease significantly improved compared to patients with periodontal disease, respectively (p < 0.01 and p = 0.01). Patients from the stimulated group had more severe neurological deficit at baseline (p = 0.04). On days three and seven of neurological follow-up, the condition of patients from both groups improved with a further distinct advantage of the unstimulated group over the stimulated group, respectively (p = 0.03 and p < 0.001). In patients from both groups, a statistically significant decrease in CRP and lymphocyte levels was observed on day seven in relation to day one. Conclusions: The occurrence of periodontal disease in a patient with stroke affects the severity of stroke. Stimulation of the mouth and salivary glands in these patients may have a positive effect on the course of stroke, taking into account the dynamics of neurological symptoms.
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Liu ZY, Han GS, Wu JJ, Sha YH, Hong YH, Fu HH, Zhou LX, Ni J, Zhu YC. Comparing characteristics and outcomes of in-hospital stroke and community-onset stroke. J Neurol 2022; 269:5617-5627. [PMID: 35780193 DOI: 10.1007/s00415-022-11244-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In-hospital strokes account for 4-17% of all strokes and usually lead to urgent and severe conditions. However, features of in-hospital strokes have been scarcely reported in China, and the management systems of in-hospital strokes are unestablished. The study aims to analyze the characteristics of in-hospital strokes in comparison to community-onset strokes and provides evidence for the development of national in-patient stroke care systems. METHODS We retrospectively analyzed consecutive patients with in-hospital strokes (IHS group) and community-onset strokes (COS group) hospitalized in our hospital between June 2012, and January 2022. Clinical characteristics, care measures, and outcomes were compared between the two groups. RESULTS A total of 1162 patients (age 61 ± 16 and 65% male) were included, of whom 193 (16.6%) had an in-hospital stroke and 969 (83.4%) had community-onset stroke. Compared with COS group, patients in IHS group had higher NIHSS at onset (7.25 vs 5.96, P = 0.054), higher use of endovascular therapy (10.4% vs 2.0%, P < 0.001), and lower use of intravascular thrombolysis (1.6% vs 7.2%, P = 0.003). Also, in-hospital strokes were associated with lower rate of mRS0-2 at discharge (OR[95%CI] = 0.674[0.49, 0.926], P = 0.015) and increased in-hospital mobility (OR[95%CI] = 3.621[1.640, 7.996], P = 0.001), after adjusting for age, sex, and cardiovascular risk factors. CONCLUSION Compared with community-onset strokes, the patients with in-hospital stroke had insufficient urgent treatment and poorer outcomes, reflecting the need for increased awareness of in-patient stroke, and strategies to streamline in-hospital acute stroke care.
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Affiliation(s)
- Zi-Yue Liu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Guang-Song Han
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Juan-Juan Wu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yu-Hui Sha
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yue-Hui Hong
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Han-Hui Fu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Li-Xin Zhou
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jun Ni
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yi-Cheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Chen PY, Chen GC, Hsiao CL, Hsu PJ, Yang FY, Liu CY, Tsou A, Chang WL, Liu HH, Lin SK. Comparison of Clinical Features, Immune-Inflammatory Markers, and Outcomes Between Patients with Acute In-Hospital and Out-of-Hospital Ischemic Stroke. J Inflamm Res 2022; 15:881-895. [PMID: 35177921 PMCID: PMC8843816 DOI: 10.2147/jir.s342830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/15/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Pei-Ya Chen
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Guei-Chiuan Chen
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Lun Hsiao
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Po-Jen Hsu
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Fu-Yi Yang
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chih-Yang Liu
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Adam Tsou
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Wan-Ling Chang
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hsiu-Hsun Liu
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Shinn-Kuang Lin
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Correspondence: Shinn-Kuang Lin, Tel +886-2-66289779 ext 3129, Fax +886-2-66289009, Email ;
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Parrino CR, Noles A, Lalla R, Mehndiratta P, Phipps M, Cronin C, Cole J, Wozniak M, Yarbrough K, Chaturvedi S. Optimizing the Recognition and Treatment of In-Hospital Stroke: Evaluation of the 2CAN Score. J Stroke Cerebrovasc Dis 2021; 30:106032. [PMID: 34419834 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Stroke-like symptoms may be difficult to appreciate due to the high incidence of stroke mimics (e.g., delirium) in the inpatient population. Many centers have adopted inpatient-specific stroke protocols with the aim of improving time to diagnosis and treatment. We aimed to assess one of these instruments, the "2CAN" score, in our patient population. MATERIALS AND METHODS A retrospective chart review was conducted for all inpatients for whom our Brain Attack Team (BAT) was called between January 2015 and June 2019. Patients were excluded if they had stroke prior to current admission, were in the emergency department at the time of BAT call, or had incomplete documentation. The 2CAN score was calculated for each patient. RESULTS The BAT was activated 201 times, and 110 patients met inclusion criteria. Twenty percent of patients had a history of atrial fibrillation, 72% hypertension, and 36% diabetes. Median NIHSS was 14.5 (IQR 5-24). Only 18% of stroke calls occurred within 24 h of hospital admission. The mean 2CAN score was 2.8. Ninety-seven (88%) patients received a final diagnosis of ischemic stroke and 13 (12%) of stroke mimics. There was no difference between 2CAN scores in the stroke and mimic groups (P = 0.91). A 2CAN score of ≥ 2 had sensitivity 83.5%, specificity 23.1%, PPV 89.0%, and NPV 15.8% for stroke. CONCLUSIONS The 2CAN score was derived and validated in a single academic center as a tool to recognize inpatient stroke. The 2CAN score had good sensitivity and positive predictive value for stroke in our cohort, but poor specificity.
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Affiliation(s)
- Christopher R Parrino
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States.
| | - Aaron Noles
- Department of Neurology, University of South Florida Health, Tampa, FL, United States
| | - Rakhee Lalla
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
| | - Prachi Mehndiratta
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
| | - Michael Phipps
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
| | - Carolyn Cronin
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
| | - John Cole
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
| | - Marcella Wozniak
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
| | - Karen Yarbrough
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, United States
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ElHabr AK, Katz JM, Wang J, Bastani M, Martinez G, Gribko M, Hughes DR, Sanelli P. Predicting 90-day modified Rankin Scale score with discharge information in acute ischaemic stroke patients following treatment. BMJ Neurol Open 2021; 3:e000177. [PMID: 34250487 PMCID: PMC8231000 DOI: 10.1136/bmjno-2021-000177] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To understand variability in modified Rankin Scale scores from discharge to 90 days in acute ischaemic stroke patients following treatment, and examine prediction of 90-day modified Rankin Scale score by using discharge modified Rankin Scale and discharge disposition. MATERIALS AND METHODS Retrospective analysis of acute ischaemic stroke patients following treatment was performed from January 2016 to March 2020. Data collection included demographic and clinical characteristics and outcomes data (modified Rankin Scale score at discharge, 30 days and 90 days and discharge disposition). Pearson's χ2 test assessed statistical differences in distribution of modified Rankin Scale scores at discharge, 30 days and 90 days. The predictive power of discharge modified Rankin Scale score and disposition quantified the association with 90-day outcome. RESULTS A total of 280 acute ischaemic stroke patients (65.4% aged ≥65 years, 47.1% female, 60.7% white) were included in the analysis. The modified Rankin Scale score significantly changed between 30 and 90 days from discharge (p<0.001) after remaining stable from discharge to 30 days (p=0.665). The positive and negative predictive values of an unfavourable long-term outcome for discharge modified Rankin Scale scores of 3-5 were 67.7% (95% CI 60.4% to 75.0%) and 82.0% (95% CI 75.1% to 88.8%), and for non-home discharge disposition were 72.4% (95% CI 64.5% to 80.2%) and 74.5% (95% CI 67.8% to 81.3%), respectively. CONCLUSIONS Discharge modified Rankin Scale score and non-home discharge disposition are good individual predictors of 90-day modified Rankin Scale score for ischaemic stroke patients following treatment.
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Affiliation(s)
- Andrew K ElHabr
- Department of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jeffrey M Katz
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jason Wang
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Mehrad Bastani
- Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | | | - Michele Gribko
- Department of Neurology, North Shore University Hospital at Manhasset, Manhasset, New York, USA
| | - Danny R Hughes
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Pina Sanelli
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
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Akbik F, Xu H, Xian Y, Shah S, Smith EE, Bhatt DL, Matsouaka RA, Fonarow GC, Schwamm LH. Trends in Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era. JAMA Neurol 2021; 77:1486-1495. [PMID: 32955582 DOI: 10.1001/jamaneurol.2020.3362] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A significant proportion of acute ischemic strokes occur while patients are hospitalized. Limited contemporary data exist on the utilization rates of intravenous thrombolysis or endovascular therapy for in-hospital stroke. Objective To use a national registry to examine temporal trends in the use of intravenous and endovascular reperfusion therapies for treatment of in-hospital stroke. Design, Setting, and Participants This retrospective cohort study analyzed data from 267 956 patients who underwent reperfusion therapy for stroke with in-hospital or out-of-hospital onset reported in the Get With the Guidelines-Stroke national registry from January 2008 to September 2018. Exposures In-hospital onset vs out-of-hospital onset of stroke symptoms. Main Outcomes and Measures Temporal trends in the use of reperfusion therapy, process measures of quality, and the association between functional outcomes and key patient characteristics, comorbidities, and treatments. Results Of 67 493 patients with in-hospital stroke onset, this study observed increased rates of vascular risk factors (standardized mean difference >10%) but no significant differences in age or sex in patients undergoing intravenous thrombolysis only (mean [interquartile range {IQR}] age, 72 [80-62] y; 53.2% female) or those undergoing endovascular therapy (mean [IQR] age, 69 [59-79] y; 49.8% female). Of these patients, 10 481 (15.5%) received intravenous thrombolysis and 2494 (3.7%) underwent endovascular therapy. Compared with 2008, in 2018 the proportion of in-hospital stroke among all stroke hospital discharges was higher (3.5% vs 2.7%; P < .001), as was use of intravenous thrombolysis (19.1% vs 9.1%; P < .001) and endovascular therapy (6.4% vs 2.5%; P < .001) in patients with in-hospital stroke, with a significant increase in endovascular therapy in mid-2015 (P < .001). Compared with patients who received intravenous thrombolysis for out-of-hospital stroke onset, those with in-hospital onset were associated with longer median (IQR) times from stroke recognition to cranial imaging (33 [18-60] vs 16 [9-26] minutes; P < .001) and to thrombolysis bolus (81 [52-125] vs 60 [45-84] minutes; P < .001). In adjusted analyses, patients with in-hospital stroke onset who were treated with intravenous thrombolysis were less likely to ambulate independently at discharge (adjusted odds ratio, 0.78; 95% CI, 0.74-0.82; P < .001) and were more likely to die or to be discharged to hospice (adjusted odds ratio, 1.39; 95% CI, 1.29-1.50; P < .001) than patients with out-of-hospital onset who also received intravenous thrombolysis treatment. Comparisons among patients treated with endovascular therapy yielded similar findings. Conclusions and Relevance In this cohort study, in-hospital stroke onset was increasingly reported and treated with reperfusion therapy. Compared with out-of-hospital stroke onset, in-hospital onset was associated with longer delays to reperfusion and worse functional outcomes, highlighting opportunities to further care for patients with in-hospital stroke onset.
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Affiliation(s)
- Feras Akbik
- Department of Neurology, Neurosurgery, Emory University Hospital, Atlanta, Georgia
| | - Haolin Xu
- Duke Clinical Research Institute, Durham, North Carolina
| | - Ying Xian
- Duke Clinical Research Institute, Durham, North Carolina
| | - Shreyansh Shah
- Duke Clinical Research Institute, Durham, North Carolina
| | - Eric E Smith
- Department of Neurology, University of Calgary, Calgary, Alberta, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center.,Harvard Medical School, Boston, Massachusetts
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Durham, North Carolina.,Department of Neurology, Duke University, Durham, North Carolina
| | - Gregg C Fonarow
- Department of Cardiology, University of California, Los Angeles Medical Center, Los Angeles
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston
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9
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Impact of a Structured Response and Evidence-Based Checklist on In-hospital Stroke Outcomes. J Neurosci Nurs 2021; 52:136-142. [PMID: 32168017 DOI: 10.1097/jnn.0000000000000508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In-hospital stroke events account for 2% to 17% of all ischemic strokes in the United States. Current stroke guidelines do not provide guidance on how to care for in-hospital stroke. Use of checklists during high-acuity events reduces error and provides clarity for responding staff. We sought to determine whether the use of an evidence-based checklist to guide in-hospital stroke response improved intervention times and patient outcomes. METHODS This study used a retrospective chart review of patients hospitalized between January 1, 2016, and December 31, 2018, at a community hospital certified as a primary stroke center with the Joint Commission. Encounters were sorted into preintervention and postintervention groups to evaluate for change in treatment rates, new or worsened disability, and mortality. Nursing staff who respond to in-hospital stroke calls ("response staff") were also surveyed regarding their perception of benefit and firsthand experience when using the checklist. RESULTS A total of 168 patient charts were reviewed (18 prechecklist, 150 postchecklist). After checklist implementation, treatment with intravenous thrombolytics for in-hospital stroke events increased from 0% to 11%. All-cause mortality decreased from 23.1% to 15.0%, whereas ambulatory disability at discharge increased from 38.0% to 62.1%. The increase in disability likely reflects the reduction in mortality, improved data collection, and the increase in postimplementation reporting. CONCLUSIONS Use of a checklist during inpatient stroke events can potentially increase adherence to guidelines for appropriate treatment and reduce mortality. Hospital response teams should consider use of a structured response system with an evidence-based checklist for high-acuity, low-frequency events such as in-hospital stroke.
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10
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Chen S, Singh RJ, Kamal N, Hill MD. Improving care for acute in-hospital ischemic strokes—A narrative review. Int J Stroke 2018; 13:905-912. [DOI: 10.1177/1747493018790029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In-hospital strokes, that is new strokes occurring among hospitalized patients, account for 6.5–15% of all strokes. Compared to community-onset stroke patients, in-hospital stroke patients tend to have worse functional and mortality outcomes. This review addresses the characteristics of acute in-hospital ischemic strokes, reasons these patients have worse outcomes compared to community-onset stroke patients, and future steps to improve outcomes.
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Affiliation(s)
- Shuo Chen
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ravinder-Jeet Singh
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Noreen Kamal
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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11
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Mining co-occurrence and sequence patterns from cancer diagnoses in New York State. PLoS One 2018; 13:e0194407. [PMID: 29698405 PMCID: PMC5919533 DOI: 10.1371/journal.pone.0194407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/19/2018] [Indexed: 11/19/2022] Open
Abstract
The goal of this study is to discover disease co-occurrence and sequence patterns from large scale cancer diagnosis histories in New York State. In particular, we want to identify disparities among different patient groups. Our study will provide essential knowledge for clinical researchers to further investigate comorbidities and disease progression for improving the management of multiple diseases. We used inpatient discharge and outpatient visit records from the New York State Statewide Planning and Research Cooperative System (SPARCS) from 2011-2015. We grouped each patient’s visit history to generate diagnosis sequences for seven most popular cancer types. We performed frequent disease co-occurrence mining using the Apriori algorithm, and frequent disease sequence patterns discovery using the cSPADE algorithm. Different types of cancer demonstrated distinct patterns. Disparities of both disease co-occurrence and sequence patterns were observed from patients within different age groups. There were also considerable disparities in disease co-occurrence patterns with respect to different claim types (i.e., inpatient, outpatient, emergency department and ambulatory surgery). Disparities regarding genders were mostly found where the cancer types were gender specific. Supports of most patterns were usually higher for males than for females. Compared with secondary diagnosis codes, primary diagnosis codes can convey more stable results. Two disease sequences consisting of the same diagnoses but in different orders were usually with different supports. Our results suggest that the methods adopted can generate potentially interesting and clinically meaningful disease co-occurrence and sequence patterns, and identify disparities among various patient groups. These patterns could imply comorbidities and disease progressions.
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Mattlage AE, Rippee MA, Sandt J, Billinger SA. Decrease in Insulin-Like Growth Factor-1 and Insulin-Like Growth Factor-1 Ratio in the First Week of Stroke Is Related to Positive Outcomes. J Stroke Cerebrovasc Dis 2016; 25:1800-1806. [PMID: 27113779 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/13/2016] [Accepted: 03/31/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND High insulin-like growth factor-1 (IGF-1), measured once during acute stroke, is associated with greater survival rates and lower stroke severity. However, information is lacking regarding how IGF-1 availability, determined by IGF-1's ratio to insulin-like growth factor binding protein-3 (IGFBP-3), relates to recovery and how the response of IGF-1 during the first week of stroke relates to outcomes. The purpose of this study was to determine the following: (1) the relationship between percent change in IGF-1 and IGF-1 ratio during the first week of stroke and stroke outcomes; and (2) the difference in percent change in IGF-1 and IGF-1 ratio in individuals being discharged home and individuals being discharged to inpatient facilities. METHODS IGF-1 and IGFBP-3 were quantified from blood sampled twice (<72 hours of admission; 1 week post stroke) in 15 individuals with acute stroke. Length of stay, modified Rankin Scale at 1 month, and discharge destination were obtained from electronic medical records. RESULTS Percent change in IGF-1 ratio was related to length of stay (r = .54; P = .04). Modified Rankin Scale (n = 10) was related to percent change in IGF-1 (r = .90; P < .001) and IGF-1 ratio (r = .75 P = .01). Individuals who went home (n = 7) had decreases in IGF-1 (-24 + 25%) and IGF-1 ratio (-36 + 50%), whereas individuals who went to inpatient facilities (n = 8) had increases in IGF-1 (37 + 46%) and IGF-1 ratio (30 + 40%). These differences were significant (IGF-1: P = .008; IGF-1 ratio: P = .01). CONCLUSION Our findings suggest that a decrease in IGF-1 and IGF-1 ratio during the first week of stroke is associated with favorable outcomes: shorter length of stay, greater independence at 1 month on the modified Rankin Scale, and discharging home.
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Affiliation(s)
- Anna E Mattlage
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Michael A Rippee
- Department of Neurology, The University of Kansas Hospital, Kansas City, Kansas
| | - Janice Sandt
- Advanced Comprehensive Stroke Center, The University of Kansas Hospital, Kansas City, Kansas
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas.
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