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Nakano Y, Mandai S, Takahashi D, Ikenouchi K, Mori Y, Ando F, Susa K, Mori T, Iimori S, Naito S, Sohara E, Fushimi K, Uchida S. Sex disparities in the risk of urgent dialysis following acute aortic dissections in Japan. iScience 2024; 27:110577. [PMID: 39211546 PMCID: PMC11357881 DOI: 10.1016/j.isci.2024.110577] [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: 05/08/2024] [Revised: 06/18/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
The global outcome of acute aortic dissection (AD) remains poor, with a high risk of the need for urgent dialysis. This study aimed to clarify the association between sex and the requirement for urgent dialysis within 30 days after admission among patients with AD. This study included 79,998 cases who were hospitalized due to AD in Japan from 2010 to 2020 using an administrative claims database. The association between the risk of urgent dialysis and sex was investigated using the Fine and Gray model. Patients were classified into two groups based on the Stanford classification: type A AD (TAAD) and type B AD (TBAD). The lower subdistribution hazard ratio (SHR) in women was observed in both groups: TAAD (SHR: 0.58, 95% confidence interval [CI]: 0.54-0.62); TBAD (SHR: 0.49, 95% CI: 0.41-0.58). Our study revealed that women had a lower risk of requiring urgent dialysis than men in TAAD and TBAD.
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Affiliation(s)
- Yuta Nakano
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Shintaro Mandai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Daiei Takahashi
- Department of Nephrology, Musashino Red Cross Hospital, 1-26-1, Kyonann-cho, Musashino-shi, Tokyo 180-8610, Japan
| | - Ken Ikenouchi
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Yutaro Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Fumiaki Ando
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Koichiro Susa
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Soichiro Iimori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
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Dumot C, Gasimov T, Hatipoglu Majernik G, Gurbuz MS, Erginoglu U, Keles A, Arat A, Baskaya MK. Nighttime Treatment of Ruptured Intracranial Aneurysms Are Associated With Poor Outcomes. Neurosurgery 2024:00006123-990000000-01228. [PMID: 38904367 DOI: 10.1227/neu.0000000000003024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/16/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Rebleeding of ruptured intracranial aneurysms (RIA) is associated with poor outcomes. Although immediate treatment of RIAs is preferred, optimal treatment timing is multifactorial and may be a complicating factor for achieving the best outcomes. The objective of this study was to compare outcomes for patients with RIAs as a function of treatment time of day. To the best of our knowledge, this is the first study that examines how treatment time of day influences treatment outcomes. METHODS This retrospective single-center study included all patients who were treated, either surgically or endovascularly, for RIAs within 24 hours after admission. Exclusion criteria were blister, mycotic or giant aneurysms, or incomplete records. The modified Rankin Scale was used to evaluate treatment outcomes using multivariate analysis. Nighttime treatment was defined when greater than 50% of the procedure was performed between 10 pm and 7 am, with other times classified as daytime treatment. Off-hours treatment was defined when more than 50% of the procedure was performed between 7 pm and 7 am, with other times classified as on-hours. RESULTS This study included 493 patients, with 84.2% (415) treated during the daytime, 15.8% (78) during the nighttime, 67.5% (333) during on-hours, and 32.5% (160) during off-hours. These groups did not differ according to age, sex, World Federation of Neurosurgical Societies and Fisher scales, aneurysm size, location, and surgical or endovascular treatment. Outcomes were favorable (modified Rankin Scale 0-2) for 72.0% (299) of patients treated during the daytime and 60.0% (46) of patients treated during the nighttime. Aneurysm treatment during the nighttime (OR: 0.50 [95% CI: 0.28-0.91], P = .023) but not during off-hours (OR: 0.76 [0.50-1.14], P = .18) was independently associated with unfavorable outcomes. CONCLUSION Nighttime treatment was associated with poorer outcomes. Further studies are needed to evaluate outcomes if treatment is postponed to daytime hours.
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Affiliation(s)
- Chloe Dumot
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Neurosurgery, Hospices Civils de Lyon, Lyon, France
| | - Turab Gasimov
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Mehmet Sabri Gurbuz
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ufuk Erginoglu
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Abdullah Keles
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Anil Arat
- Department of Radiology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Jun SM, Kim SH, Leinonen H, Gan P, Bhat S. Impact of Off-Hour Admission with Subarachnoid Hemorrhage: A Meta-Analysis. World Neurosurg 2022; 166:e872-e891. [PMID: 35948214 DOI: 10.1016/j.wneu.2022.07.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This meta-analysis assessed the impact of off-hour hospitalization (weekends, and evenings or nighttime on weekdays) on mortality and morbidity in patients with nontraumatic subarachnoid hemorrhage (SAH). METHODS Electronic databases were systematically searched for studies comparing outcomes between patients with nontraumatic SAH hospitalized during off-hour and on-hour periods (daytime on weekdays). The primary outcome was mortality (in-hospital and at different follow-up periods after hospitalization). Secondary outcomes included delays in treatment, and complications. Sensitivity analysis including only studies in which adjusted multivariate analyses were performed for any of the outcomes, and meta-regression controlling for clinically important patient factors, were also performed. RESULTS Sixteen studies were included. There was no significant difference in in-hospital mortality (adjusted odds ratio, 1.03; 95% confidence interval [CI], 0.97-1.09; P = 0.30) and at all follow-up periods (7/14 days and 1/3/6 months) after hospitalization between SAH patients who were admitted during off-hour compared with on-hour periods, despite adjusted multivariate meta-analysis being performed. However, patients who were admitted during off-hour periods experienced greater delays from their initial scan to treatment (mean difference, 42.7, 25.2-60.1 hours; P < 0.0001) and had higher rates of pneumonia (odds ratio, 1.65, 1.12-2.44; P = 0.011). CONCLUSIONS This meta-analysis has not shown an increased risk of mortality in the short-term and long-term among patients with nontraumatic SAH who were hospitalized during off-hour compared with on-hour periods, despite adjusting for potentially confounding patient factors. The delays to treatment and higher observed rates of pneumonia highlight areas in which hospital services and resources should be targeted during these off-hour periods in patients presenting with nontraumatic SAH.
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Affiliation(s)
- Sung-Min Jun
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sang Ho Kim
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Heta Leinonen
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand
| | - Peter Gan
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand
| | - Sameer Bhat
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Department of Surgery, Palmerston North Hospital, Palmerston North, New Zealand.
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Kido T, Iwagami M, Abe T, Enomoto Y, Takada H, Tamiya N. Association between off-hour admission of critically ill children to intensive care units and mortality in a Japanese registry. Sci Rep 2021; 11:14988. [PMID: 34294821 PMCID: PMC8298565 DOI: 10.1038/s41598-021-94482-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022] Open
Abstract
Limited information exists regarding the effect of off-hour admission among critically ill children. To evaluate whether children admitted to intensive care units (ICUs) in off-hour have worse outcomes, we conducted a cohort study in 2013–2018 in a multicenter registry in Japan. Pediatric (age < 16 years) unplanned ICU admissions were divided into regular-hour (daytime on business days) or off-hour (others). Mortality and changes in the functional score at discharge from the unit were compared between the two groups. We established multivariate logistic regression models to examine the independent association between off-hour admission and outcomes. Due to the small number of outcomes, two different models were used. There were 2512 admissions, including 757 for regular-hour and 1745 for off-hour. Mortality rates were 2.4% (18/757) and 1.9% (34/1745) in regular-hour and off-hour admissions, respectively. There was no significant association between off-hour admission and mortality both in model 1 adjusting for age, sex, and Pediatric Index of Mortality 2 (adjusted odds ratio [aOR] 0.89, 95% confidence interval [CI] 0.46–1.72) and in model 2 adjusting for propensity score predicting off-hour admission (aOR 1.05, 95% CI 0.57–1.91). In addition, off-hour admission did not show an independent association with deterioration of functional score.
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Affiliation(s)
- Takahiro Kido
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan. .,Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
| | - Toshikazu Abe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.,Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.,Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki, Japan
| | - Yuki Enomoto
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan.,Department of Critical Care and Emergency Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan.,Department of Child Health, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.,Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
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Räty S, Martinez-Majander N, Suomalainen O, Sibolt G, Tiainen M, Valkonen K, Sairanen T, Forss N, Curtze S. Is the weekend effect true in acute stroke patients at tertiary stroke center? J Neurol Sci 2021; 427:117557. [PMID: 34214920 DOI: 10.1016/j.jns.2021.117557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/24/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is contradicting evidence on the outcome of emergency patients treated during weekends versus weekdays. We studied if outcome of ischemic stroke patients receiving intravenous thrombolysis (IVT) differs according to the treatment time. METHODS Our retrospective study included consecutive patients receiving IVT within 4.5 h of stroke onset between June 1995 and December 2018 at the Helsinki University Hospital. The patients were compared based on the treatment initiation either during weekdays (Monday to Friday) or weekend (Saturday and Sunday). The primary outcome was 3-month mortality and secondary outcomes comprised 3-month modified Rankin Scale (mRS) and incidence of symptomatic intracerebral hemorrhage (sICH). Additional analyses studied the effect of IVT treatment according to non-office hours, time of day, and season. RESULTS Of the 3980 IVT-treated patients, 28.0% received treatment during weekends. Mortality was similar after weekend (10.0%) and weekday (10.6%) admissions in the multivariable regression analysis (OR 0.78; 95% CI 0.59-1.03). Neither 3-month mRS (OR 0.98; 95% CI 0.86-1.12), nor the occurrence of sICH (4.2% vs 4.6%; OR 0.87; 95% CI 0.60-1.26) differed between the groups. No outcome difference was observed between the office vs non-office hours or by the time of day. However, odds for worse outcome were higher during autumn (OR 1.19; 95% CI 1.04-1.35) and winter (OR 1.15; 95% CI 1.01-1.30). CONCLUSION We did not discover any weekend effect for IVT-treated stroke patients. This confirms that with standardized procedures, an equal quality of care can be provided to patients requiring urgent treatment irrespective of time.
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Affiliation(s)
- Silja Räty
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Olli Suomalainen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjaana Tiainen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kati Valkonen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Sairanen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nina Forss
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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6
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Funakoshi Y, Hata N, Kuga D, Hatae R, Sangatsuda Y, Fujioka Y, Takigawa K, Yoshimoto K, Mizoguchi M, Iihara K. Current trend in treatment of glioblastoma in Japan: a national survey using the diagnostic procedure combination database (J-ASPECT study-glioblastoma). Int J Clin Oncol 2021; 26:1441-1449. [PMID: 33974184 PMCID: PMC8286941 DOI: 10.1007/s10147-021-01929-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/01/2021] [Indexed: 11/29/2022]
Abstract
Background In the treatment for glioblastoma (GBM), treatment modalities, such as bevacizumab (BEV) and carmustine wafers implants have been approved in Japan since 2013. However, it is unclear whether such a trend in treatment complexity can accelerate treatment centralization. The aim of this study was to reveal the current trend in the treatment of GBM in Japan. Methods We used diagnostic procedure combination (DPC) database to analyze the data of 1,774 patients from 305 institutions between April 2016 and March 2019. To analyze the situations associated with first-line BEV use during concurrent TMZ (temozolomide)-radiotherapy, we compared TMZ alone and TMZ–BEV groups. Results Of the 1,774 patients with GBM, tumor removal by craniotomy was performed in 1,572 (88.6%) patients, and stereotactic biopsy was performed in 156 (8.8%) patients. A total of 1,229 (69.3%) patients underwent radiotherapy, and 1,287 (72.5%) patients underwent chemotherapy. TMZ alone was administered to 878 (68.2%) and TMZ combined with BEV in 381 (29.6%) patients. In the TMZ–BEV group, as compared to the TMZ-alone group, the rate of discharge to home was significantly lower (P = 0.0044), and the rate of stereotactic biopsy was significantly higher (P < 0.0001). No significant difference was observed in the distribution of patients between the TMZ alone and TMZ–BEV groups depending on the scale of institution (P = 0.1240). Conclusion First-line BEV administration seems to be selected properly regardless of the institutional scale. This Japan-wide study of GBM treatment revealed that high level and newly introduced treatments have been steadily generalized in Japanese institutions.
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Affiliation(s)
- Yusuke Funakoshi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Nobuhiro Hata
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Ryusuke Hatae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuhei Sangatsuda
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yutaka Fujioka
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kosuke Takigawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.,Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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Risk of Short-Term Mortality after Intracerebral Haemorrhage due to Weekend Hospital Admission in Poland. Emerg Med Int 2020; 2020:2198384. [PMID: 33376607 PMCID: PMC7744225 DOI: 10.1155/2020/2198384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/31/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022] Open
Abstract
Background The mortality rate for spontaneous intracerebral haemorrhage (ICH) has remained high and stable for many years. The unfavourable prognostic factors include age, bleeding volume, location of the haematoma, high blood pressure, and disturbed consciousness on admission. Other risk factors associated with medical care also deserve attention. The study aimed to analyse the relationship between day of admission, concerning other prognostic factors, and short-term mortality in ICH, in a Polish specialist stroke unit. Methods Medical records of 156 patients (74 males, 82 females, mean age 68.7 years) diagnosed with spontaneous ICH and admitted to a specialist stroke center were retrospectively analysed. Demographics, location, volume of bleeding, blood pressure values, and the Glasgow Coma Scale (GCS), as well as the day of admission, were determined. The relationships were analysed between these factors and 30-day mortality in the patients with ICH. Results A total of 83 patients were admitted to the hospital during weekdays (Monday 8 am to Friday 3 pm) and 73 during weekends or holidays. Of these, 65 patients died within 30 days. Patients admitted at weekends initially presented with lower GCS scores. Admission on Saturday was associated with an increased risk of death (OR 3.38, 95% CI 1.2–9.48, p < 0.05), but after correction for clinical state measured with the GCS and ICH score, the association was no longer significant. Conclusions The time and mode of admission were not associated with increased risk of short-term mortality in ICH patients. Prehospital care issues should be additionally considered as prognostic factors of the outcome.
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Kim T, Jwa C. Impact of Off-Hour Hospital Presentation on Mortality in Different Subtypes of Acute Stroke in Korea : National Emergency Department Information System Data. J Korean Neurosurg Soc 2020; 64:51-59. [PMID: 33267532 PMCID: PMC7819795 DOI: 10.3340/jkns.2020.0127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/25/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Several studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea.
Methods We respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. “Off-hour hospital presentation” was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox's proportional hazard model.
Results In subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106–1.400; HR, 1.402; 95% CI, 1.124–1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH.
Conclusion This study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.
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Affiliation(s)
- Taikwan Kim
- Department of Neurosurgery, Incheon Hospital 21, Incheon, Korea
| | - Cheolsu Jwa
- Department of Neurosurgery, National Medical Center, Seoul, Korea
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Toyokawa S, Hasegawa J, Ikenoue T, Asano Y, Jojima E, Satoh S, Ikeda T, Ichizuka K, Takeda S, Tamiya N, Nakai A, Fujimori K, Maeda T, Masuzaki H, Suzuki H, Ueda S. Weekend and off-hour effects on the incidence of cerebral palsy: contribution of consolidated perinatal care. Environ Health Prev Med 2020; 25:52. [PMID: 32912144 PMCID: PMC7488476 DOI: 10.1186/s12199-020-00889-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022] Open
Abstract
Objective This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy. Methods The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database. Results A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06–2.81) and during the night shift (OR 2.29, 95% CI 1.30–4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97–2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70–2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47–3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76–4.84). Conclusion Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.
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Affiliation(s)
- Satoshi Toyokawa
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.
| | - Junichi Hasegawa
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Yuri Asano
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Emi Jojima
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shoji Satoh
- Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihito Nakai
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | | | - Hideaki Masuzaki
- Department of Obstetrics and Gynecology, University of Nagasaki, Nagasaki, Japan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shigeru Ueda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
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10
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Huang HK, Chang WC, Hsu JY, Wang JH, Liu PS, Lin SM, Loh CH. Holiday Season and Weekend Effects on Stroke Mortality: A Nationwide Cohort Study Controlling for Stroke Severity. J Am Heart Assoc 2020; 8:e011888. [PMID: 30973048 PMCID: PMC6507216 DOI: 10.1161/jaha.118.011888] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The effect of holiday season admission for stroke on mortality has not been investigated. Thus, we aimed to evaluate whether "holiday season" and "weekend" effects exist on mortality risk for stroke admission. Methods and Results A nationwide cohort study was conducted using Taiwan's National Health Insurance Research Database. We identified all patients admitted for stroke between 2011 and 2015 in Taiwan, and categorized them according to the admission date: holiday season (at least 4 days off) (n=3908), weekend (n=13 774), and weekday (n=49 045). We analyzed in-hospital, 7-day, and 30-day mortality using multivariable logistic regression, adjusting for stroke severity and other confounders. Compared with weekday admissions, holiday season admission for stroke was significantly associated with a 20%, 33%, and 21% increase in in-hospital, 7-day, and 30-day mortality, respectively. Compared with weekend admissions, holiday season admissions were associated with a 24%, 30%, and 22% increased risk of in-hospital, 7-day, and 30-day mortality, respectively. However, mortality did not differ significantly between weekend and weekday admissions. Subanalyses after stratification for age, sex, and stroke type also revealed similar trends. Conclusions We report for the first time a "holiday season effect" on stroke mortality. Patients admitted during holiday seasons had higher mortality risks than those admitted on weekends and weekdays. This holiday season effect persisted even after adjusting for stroke severity and other important confounders. These findings highlight the need for healthcare delivery systems with a consistent quality of round-the-clock care for patients admitted for stroke.
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Affiliation(s)
- Huei-Kai Huang
- 1 Department of Family Medicine Buddhist Tzu Chi General Hospital Hualien Taiwan
| | - Wei-Chuan Chang
- 2 Department of Medical Research Buddhist Tzu Chi General Hospital Hualien Taiwan
| | - Jin-Yi Hsu
- 3 Department of Neurology Buddhist Tzu Chi General Hospital Hualien Taiwan
| | - Jen-Hung Wang
- 2 Department of Medical Research Buddhist Tzu Chi General Hospital Hualien Taiwan
| | - Pin-Sung Liu
- 5 Center for Aging and Health Buddhist Tzu Chi General Hospital Hualien Taiwan
| | - Shu-Man Lin
- 4 Department of Physical Medicine and Rehabilitation Buddhist Tzu Chi General Hospital Hualien Taiwan
| | - Ching-Hui Loh
- 5 Center for Aging and Health Buddhist Tzu Chi General Hospital Hualien Taiwan
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11
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Angerer S, Buttinger K, Stummer H. The weekend effect revisited: evidence from the Upper Austrian stroke registry. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:729-737. [PMID: 30756194 DOI: 10.1007/s10198-019-01035-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
Empirical evidence on the so-called 'weekend-effect' on stroke mortality is mixed with some studies reporting significantly higher mortality for weekend admissions and others finding no difference. The aim of this paper is to enhance the evidence on the weekend-effect on stroke mortality using a rich stroke registry data set from Upper Austria and to discuss underlying reasons for the heterogeneity in results. Using logistic regressions and ordinary least squares regressions with hospital and year-fixed effects, the outcomes of weekend versus weekday admissions are compared for patients admitted to 16 hospitals in Upper Austria with transient ischemic attack (TIA), cerebral infarction or hemorrhage between 2007 and 2015. The primary outcomes include in-hospital mortality, 30-day and 90-day all-cause mortality as well as the length of hospital stay. In addition, we analyze differences in process-quality indicators between weekdays and weekends. Our results show that on weekends there are on average 25% fewer admissions than on weekdays with significantly higher in-hospital mortality. Adjusting for case-mix, the association between weekend admissions and mortality becomes null suggesting that the higher mortality on weekends is explained by heterogeneities in admissions rather than health-care quality.
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Affiliation(s)
- Silvia Angerer
- UMIT, University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria
| | - Klaus Buttinger
- UMIT, University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria
- Salzkammergut Klinikum, Miller-von-Aichholz-Straße 49, 4810, Gmunden, Austria
| | - Harald Stummer
- UMIT, University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
- University Seeburg Castle, Institut für Gesundheitsmanagement und Innovation, Seeburgstraße 8, 5201, Seekirchen am Wallersee, Austria.
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12
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Comparison of outcome in stroke patients admitted during working hours vs. off-hours; a single-center cohort study. J Neurol 2018; 266:782-789. [DOI: 10.1007/s00415-018-9079-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
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13
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Reznik ME, Yaghi S, Jayaraman MV, McTaggart RA, Hemendinger M, Mac Grory BC, Burton TM, Cutting SM, Thompson BB, Wendell LC, Mahta A, Potter NS, Daiello LA, Kosar CM, Jones RN, Furie KL. Level of consciousness at discharge and associations with outcome after ischemic stroke. J Neurol Sci 2018; 390:102-107. [PMID: 29801867 DOI: 10.1016/j.jns.2018.04.022] [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: 12/29/2017] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Many factors may potentially complicate the stroke recovery process, including persistently impaired level of consciousness (LOC)-whether from residual stroke effects or from superimposed delirium. We aimed to determine the degree to which impaired LOC at hospital discharge is associated with outcomes after ischemic stroke. METHODS We conducted a single-center retrospective cohort study using prospectively-collected data from 2015 to 2017, collecting total NIHSS-LOC score at discharge as well as subscores for responsiveness (LOC-R), orientation questions (LOC-Q), and command-following (LOC-C). We determined associations between LOC scores and 3-month outcome using logistic regression, with discharge location (skilled nursing facility [SNF] vs. inpatient rehabilitation) representing a pre-specified secondary outcome. RESULTS We identified 1003 consecutive patients with ischemic stroke who survived to discharge, of whom 32% had any LOC score > 0. Total LOC score at discharge was associated with unfavorable 3-month outcome (OR 4.9 [95% CI 2.4-9.8] for LOC = 1; OR 8.0 [2.7-23.9] for LOC = 2-3; OR 6.3 [2.1-18.5] for LOC = 4-5; all patients with LOC = 6-7 had poor outcomes), as were subscores for LOC-R (OR 5.3 [1.3-21.2] for LOC-R = 1; all patients with LOC-R = 2-3 had poor outcomes) and LOC-Q (OR 4.1 [2.1-8.3] for LOC-Q = 1; OR 4.9 [1.8-13.5] for LOC-Q = 2). Total LOC score (OR 2.6 [1.3-5.3] for LOC = 1; OR 3.1 [1.2-8.2] for LOC = 2-3) and LOC-Q (OR 3.3 [1.6-6.6] for LOC-Q = 1; OR 3.4 [1.3-9.0] for LOC-Q = 2) were also associated with discharge to SNF rather than to inpatient rehabilitation. CONCLUSIONS The presence of impaired consciousness or disorientation at discharge is associated with markedly worse outcomes after ischemic stroke. Further studies are necessary to determine the separate effects of residual stroke-related LOC changes and those caused by superimposed delirium.
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Affiliation(s)
- Michael E Reznik
- Department of Neurology, Warren Alpert Medical School, Brown University, United States; Department of Neurosurgery, Warren Alpert Medical School, Brown University, United States.
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School, Brown University, United States
| | - Mahesh V Jayaraman
- Department of Neurology, Warren Alpert Medical School, Brown University, United States; Department of Neurosurgery, Warren Alpert Medical School, Brown University, United States; Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, United States
| | - Ryan A McTaggart
- Department of Neurology, Warren Alpert Medical School, Brown University, United States; Department of Neurosurgery, Warren Alpert Medical School, Brown University, United States; Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, United States
| | - Morgan Hemendinger
- Department of Neurology, Warren Alpert Medical School, Brown University, United States
| | - Brian C Mac Grory
- Department of Neurology, Warren Alpert Medical School, Brown University, United States
| | - Tina M Burton
- Department of Neurology, Warren Alpert Medical School, Brown University, United States
| | - Shawna M Cutting
- Department of Neurology, Warren Alpert Medical School, Brown University, United States
| | - Bradford B Thompson
- Department of Neurology, Warren Alpert Medical School, Brown University, United States; Department of Neurosurgery, Warren Alpert Medical School, Brown University, United States
| | - Linda C Wendell
- Department of Neurology, Warren Alpert Medical School, Brown University, United States; Department of Neurosurgery, Warren Alpert Medical School, Brown University, United States
| | - Ali Mahta
- Department of Neurology, Warren Alpert Medical School, Brown University, United States; Department of Neurosurgery, Warren Alpert Medical School, Brown University, United States
| | - N Stevenson Potter
- Department of Neurology, Warren Alpert Medical School, Brown University, United States; Department of Neurosurgery, Warren Alpert Medical School, Brown University, United States
| | - Lori A Daiello
- Department of Neurology, Warren Alpert Medical School, Brown University, United States
| | - Cyrus M Kosar
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, United States
| | - Richard N Jones
- Department of Neurology, Warren Alpert Medical School, Brown University, United States; Department of Psychiatry, Warren Alpert Medical School, Brown University, United States
| | - Karen L Furie
- Department of Neurology, Warren Alpert Medical School, Brown University, United States
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14
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Suo Y, Chen WQ, Pan YS, Peng YJ, Yan HY, Zhao XQ, Liu LP, Wang YL, Liu GF, Wang YJ. The max-intracerebral hemorrhage score predicts long-term outcome of intracerebral hemorrhage. CNS Neurosci Ther 2018. [PMID: 29529353 DOI: 10.1111/cns.12846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIMS Little is known about the performance of the maximally treated intracerebral hemorrhage (max-ICH) score in predicting unfavorable long-term functional outcome and death in patients with intracerebral hemorrhage (ICH) in China. We aimed to validate the performance of the max-ICH score and compared it with other recognized scores. METHODS We derived data from the China National Stroke Registry (CNSR). Receiver-operating characteristic (ROC) analysis and Hosmer-Lemeshow test were used to measure the score performance. We compared the performance of max-ICH score with six recognized models, including the ICH score, ICH functional outcome score (ICH-FOS), Essen-ICH score, modified intracerebral hemorrhage (MICH) score, intracerebral hemorrhage grading scale (ICH-GS), and functional outcome (FUNC) score. RESULTS A total of 2581 patients with spontaneous ICH were enrolled in the study. The max-ICH score was similar or superior to the six existing scores in predicting long-term unfavorable functional outcome after ICH with good discrimination (AUC 0.83, 95% confidence interval [CI] 0.81-0.84) and calibration (Hosmer-Lemeshow P = 0.19). For predicting death, the AUC of max-ICH was 0.81 (95% CI 0.79-0.83). CONCLUSIONS The easy-to-use max-ICH score is a reliable tool to predict unfavorable long-term (12-month) functional outcome and death after intracerebral hemorrhage in the Chinese population.
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Affiliation(s)
- Yue Suo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Wei-Qi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yue-Song Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yu-Jing Peng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hong-Yi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xing-Quan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Li-Ping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yi-Long Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Gai-Fen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong-Jun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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15
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Willers C, Lekander I, Ekstrand E, Lilja M, Pessah-Rasmussen H, Sunnerhagen KS, von Euler M. Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study. Biol Sex Differ 2018. [PMID: 29514685 PMCID: PMC5842547 DOI: 10.1186/s13293-018-0170-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Differences in stroke care and health outcomes between men and women are debated. The objective of this study was to explore the relationship between patients' sex and post-stroke health outcomes and received care in a Swedish setting. METHODS Patients with a registered diagnosis of acute intracerebral hemorrhage (ICH) or ischemic stroke (IS) within regional administrative systems (ICD-10 codes I61* or I63*) and the Swedish Stroke Register during 2010-2011 were included and followed for 1 year. Data linkage to multiple other data sources on individual level was performed. Adjustments were performed for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity in multivariate regression analyses of health outcomes and received care. Health outcomes (e.g., survival, functioning, satisfaction) and received care measures (regional and municipal resources and processes) were studied. RESULTS Study population: 13,775 women and 13,916 men. After case-mix adjustments for the above factors, we found women to have higher 1-year survival rates after both IS (ORfemale = 1.17, p < 0.001) and ICH (ORfemale = 1.65, p < 0.001). Initial inpatient stay at hospital was, however, shorter for women (βfemale, IS = - 0.05, p < 0.001; βfemale, ICH = - 0.08, p < 0.005). For IS, good function (mRS ≤ 2) was more common in men (ORfemale = 0.86, p < 0.001) who also received more inpatient care during the first year (βfemale = - 0.05, p < 0.001). CONCLUSIONS A lower proportion of women had good functioning, a difference that remained in IS after adjustments for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity. The amount of received hospital care was lower for women after adjustments. Whether shorter hospital stay results in lower function or is a consequence of lower function cannot be elucidated. One-year survival was higher in men when no adjustments were made but lower after adjustments. This likely reflects that women were older at time of stroke, had more severe strokes, and more disability pre-stroke-factors that make a direct comparison between the sexes intricate.
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Affiliation(s)
- Carl Willers
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 61, Stockholm, Sweden. .,Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden. .,Ivbar Institute AB, Stockholm, Sweden.
| | - Ingrid Lekander
- Ivbar Institute AB, Stockholm, Sweden.,Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development, Östersund, Umeå University, Umeå, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mia von Euler
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 61, Stockholm, Sweden.,Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden.,Center for Gender Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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16
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Attenello FJ, Mack WJ. Pitfalls of administrative database analysis are evident when assessing the 'weekend effect' in stroke. ACTA ACUST UNITED AC 2016; 22:35. [PMID: 27815303 DOI: 10.1136/ebmed-2016-110557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Frank J Attenello
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - William J Mack
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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17
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Yoshimoto K, Kada A, Kuga D, Hatae R, Murata H, Akagi Y, Nishimura K, Kurogi R, Nishimura A, Hata N, Mizoguchi M, Sayama T, Iihara K. Current Trends and Healthcare Resource Usage in the Hospital Treatment of Primary Malignant Brain Tumor in Japan: A National Survey Using the Diagnostic Procedure Combination Database (J-ASPECT Study-Brain Tumor). Neurol Med Chir (Tokyo) 2016; 56:664-673. [PMID: 27680329 PMCID: PMC5221777 DOI: 10.2176/nmc.oa.2016-0172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We conducted this study to clarify the current trends and healthcare resource usage in the treatment of inpatients with primary malignant brain tumors. The Diagnostic Procedure Combination (DPC) data of all inpatients treated between 2013 and 2014 in the 370 core and branch hospitals enrolled in the Japanese Neurosurgical Society training program were collected. DPC is a discharge abstract and administrative claims database of inpatients. We assessed 6,142 primary, malignant brain tumor patients. Patient information, diagnostic information, treatment procedure, and healthcare resource usage were analyzed. Chemotherapy was the most frequent treatment (27% of cases), followed by surgery (13%) and surgery + chemo-radiotherapy (11%). Temozolomide (TMZ), the most frequently used chemotherapeutic drug, was administered to 1,236 patients. Concomitant TMZ and radiotherapy was administered to 816 patients, and was performed according to the Stupp regimen in many cases. The mean length of hospital stay (LOS) was 16 days, and the mean medical cost was 1,077,690 yen. The average medical cost of TMZ-only treatment was 1,138,620 yen whilst it was 4,424,300 yen in concomitant TMZ patients. The LOS was significantly shorter in high-volume than in low-volume hospitals, and the medical cost was higher in hospitals treating 21–50 patients compared to those treating 1–10 patients. However, the direct medical cost of TMZ treatment was the same across different volume hospitals. This is the first report of current trends and healthcare resource usage in the treatment of primary malignant brain tumor inpatients in the TMZ era in Japan.
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Affiliation(s)
- Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
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18
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Watanabe E, Yamamoto M, Kodama I, Inoue H, Atarashi H, Okumura K, Yamashita T, Lip GY, Kodani E, Okuyama Y, Chishaki A, Kiyono K, Origasa H. Net clinical benefit of adding aspirin to warfarin in patients with atrial fibrillation: Insights from the J-RHYTHM Registry. Int J Cardiol 2016; 212:311-7. [DOI: 10.1016/j.ijcard.2016.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/22/2016] [Accepted: 03/12/2016] [Indexed: 11/30/2022]
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19
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Hsieh CY, Lin HJ, Chen CH, Li CY, Chiu MJ, Sung SF. "Weekend effect" on stroke mortality revisited: Application of a claims-based stroke severity index in a population-based cohort study. Medicine (Baltimore) 2016; 95:e4046. [PMID: 27336904 PMCID: PMC4998342 DOI: 10.1097/md.0000000000004046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index.This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P < 0.001) and stroke severity index (7.8 vs 7.4, P < 0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08-1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95-1.20).The "weekend effect" on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.
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Affiliation(s)
| | | | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan
- Department of Public Health, China Medical University, Taichung
| | - Meng-Jun Chiu
- Department of Public Health, College of Medicine, Tainan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
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20
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Li L, Rothwell PM. Biases in detection of apparent "weekend effect" on outcome with administrative coding data: population based study of stroke. BMJ 2016; 353:i2648. [PMID: 27185754 PMCID: PMC4868367 DOI: 10.1136/bmj.i2648] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine the accuracy of coding of admissions for stroke on weekdays versus weekends and any impact on apparent outcome. DESIGN Prospective population based stroke incidence study and a scoping review of previous studies of weekend effects in stroke. SETTING Primary and secondary care of all individuals registered with nine general practices in Oxfordshire, United Kingdom (OXVASC, the Oxford Vascular Study). PARTICIPANTS All patients with clinically confirmed acute stroke in OXVASC identified with multiple overlapping methods of ascertainment in 2002-14 versus all acute stroke admissions identified by hospital diagnostic and mortality coding alone during the same period. MAIN OUTCOMES MEASURES Accuracy of administrative coding data for all patients with confirmed stroke admitted to hospital in OXVASC. Difference between rates of "false positive" or "false negative" coding for weekday and weekend admissions. Impact of inaccurate coding on apparent case fatality at 30 days in weekday versus weekend admissions. Weekend effects on outcomes in patients with confirmed stroke admitted to hospital in OXVASC and impacts of other potential biases compared with those in the scoping review. RESULTS Among 92 728 study population, 2373 episodes of acute stroke were ascertained in OXVASC, of which 826 (34.8%) mainly minor events were managed without hospital admission, 60 (2.5%) occurred out of the area or abroad, and 195 (8.2%) occurred in hospital during an admission for a different reason. Of 1292 local hospital admissions for acute stroke, 973 (75.3%) were correctly identified by administrative coding. There was no bias in distribution of weekend versus weekday admission of the 319 strokes missed by coding. Of 1693 admissions for stroke identified by coding, 1055 (62.3%) were confirmed to be acute strokes after case adjudication. Among the 638 false positive coded cases, patients were more likely to be admitted on weekdays than at weekends (536 (41.0%) v 102 (26.5%); P<0.001), partly because of weekday elective admissions after previous stroke being miscoded as new stroke episodes (267 (49.8%) v 26 (25.5%); P<0.001). The 30 day case fatality after these elective admissions was lower than after confirmed acute stroke admissions (11 (3.8%) v 233 (22.1%); P<0.001). Consequently, relative 30 day case fatality for weekend versus weekday admissions differed (P<0.001) between correctly coded acute stroke admissions and false positive coding cases. Results were consistent when only the 1327 emergency cases identified by "admission method" from coding were included, with more false positive cases with low case fatality (35 (14.7%)) being included for weekday versus weekend admissions (190 (19.5%) v 48 (13.7%), P<0.02). Among all acute stroke admissions in OXVASC, there was no imbalance in baseline stroke severity for weekends versus weekdays and no difference in case fatality at 30 days (adjusted odds ratio 0.85, 95% confidence interval 0.63 to 1.15; P=0.30) or any adverse "weekend effect" on modified Rankin score at 30 days (0.78, 0.61 to 0.99; P=0.04) or one year (0.76, 0.59 to 0.98; P=0.03) among incident strokes. CONCLUSION Retrospective studies of UK administrative hospital coding data to determine "weekend effects" on outcome in acute medical conditions, such as stroke, can be undermined by inaccurate coding, which can introduce biases that cannot be reliably dealt with by adjustment for case mix.
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Affiliation(s)
- Linxin Li
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, OX3 9DU, UK
| | - Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, OX3 9DU, UK
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Inoue T, Fushimi K. Weekend versus Weekday Admission and In-Hospital Mortality from Ischemic Stroke in Japan. J Stroke Cerebrovasc Dis 2015; 24:2787-92. [PMID: 26365617 DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/29/2015] [Accepted: 08/09/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The initial treatment of acute ischemic stroke critically affects patient outcome. Patient outcome may also be associated with the day of hospital admission due to differences in the number of the hospital staff between weekdays and weekends. We aimed to assess the effect of weekend admission on in-hospital mortality among patients with ischemic stroke in Japan. METHODS We analyzed patients with ischemic stroke from a large nationwide administrative dataset. The patients were grouped according to the treatment ward to which they were initially admitted: a general medical ward (GMW) or an intensive or stroke care unit (S-ICU). The primary outcome, in-hospital mortality, was compared between the patients admitted on a weekday versus weekend according to the initial treatment ward. A generalized estimated equation was applied for multivariate analysis. RESULTS In total, 47,885 patients were included in the study. Of these patients, 32.0% were admitted to an S-ICU and 27.8% were admitted to a GMW on a weekend. The estimated in-hospital mortality rate was significantly higher among the patients admitted to a GMW on a weekend compared with those admitted on a weekday (7.9% versus 7.0%), but this difference was not significant after adjusting for the patients' background characteristics. The estimated in-hospital mortality rates of the patients admitted to an S-ICU were similar between weekend and weekday admissions (10.0% versus 9.9%). CONCLUSIONS No significant effect of weekend admission in-hospital mortality was observed in our study population regardless of the initial treatment ward.
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Affiliation(s)
- Takahiro Inoue
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan.
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Nishimura K. Big Data Visualization of Acute Stroke Care Practices using a Nationwide Neurosurgeon Survey. ACTA ACUST UNITED AC 2015. [DOI: 10.7887/jcns.24.676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kunihiro Nishimura
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
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