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Vagal A, Sanelli P, Sucharew H, Alwell KA, Khoury JC, Khatri P, Woo D, Flaherty M, Kissela BM, Adeoye O, Ferioli S, De Los Rios La Rosa F, Martini S, Mackey J, Kleindorfer D. Age, Sex, and Racial Differences in Neuroimaging Use in Acute Stroke: A Population-Based Study. AJNR Am J Neuroradiol 2017; 38:1905-1910. [PMID: 28838913 DOI: 10.3174/ajnr.a5340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 06/05/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Limited information is available regarding differences in neuroimaging use for acute stroke work-up. Our objective was to assess whether race, sex, or age differences exist in neuroimaging use and whether these differences depend on the care center type in a population-based study. MATERIALS AND METHODS Patients with stroke (ischemic and hemorrhagic) and transient ischemic attack were identified in a metropolitan, biracial population using the Greater Cincinnati/Northern Kentucky Stroke Study in 2005 and 2010. Multivariable regression was used to determine the odds of advanced imaging use (CT angiography/MR imaging/MR angiography) for race, sex, and age. RESULTS In 2005 and 2010, there were 3471 and 3431 stroke/TIA events, respectively. If one adjusted for covariates, the odds of advanced imaging were higher for younger (55 years or younger) compared with older patients, blacks compared with whites, and patients presenting to an academic center and those seen by a stroke team or neurologist. The observed association between race and advanced imaging depended on age; in the older age group, blacks had higher odds of advanced imaging compared with whites (odds ratio, 1.34; 95% CI, 1.12-1.61; P < .01), and in the younger group, the association between race and advanced imaging was not statistically significant. Age by race interaction persisted in the academic center subgroup (P < .01), but not in the nonacademic center subgroup (P = .58). No significant association was found between sex and advanced imaging. CONCLUSIONS Within a large, biracial stroke/TIA population, there is variation in the use of advanced neuroimaging by age and race, depending on the care center type.
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Affiliation(s)
- A Vagal
- From the Departments of Radiology (A.V.)
| | - P Sanelli
- Department of Radiology (P.S.), Hofstra Northwell School of Medicine, Hempstead, New York
| | - H Sucharew
- Department of Biostatistics and Epidemiology (H.S., J.C.K.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - K A Alwell
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - J C Khoury
- Department of Biostatistics and Epidemiology (H.S., J.C.K.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - P Khatri
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - D Woo
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Flaherty
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - B M Kissela
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | | | - S Ferioli
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - F De Los Rios La Rosa
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio.,Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, Florida.,University of New Mexico Health Sciences Center and Department of Neurology (F.D.L.R.L.R.), Albuquerque, New Mexico
| | - S Martini
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - J Mackey
- Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis, Indiana
| | - D Kleindorfer
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
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Green J, Khoury J, Rademacher E, Woo D, Khatri P, Flaherty M, Adeoye O, Ferioli S, Kissela B, Kleindorfer D. Sources of Knowledge for Stroke Warning Signs and Risk Factors within a Population (P07.051). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kissela B, Alwell K, Khoury J, Moomaw C, Embi P, Rademacher E, Lindsell C, Woo D, Flaherty M, Khatri P, Adeoye O, Ferioli S, Kleindorfer D. A Pilot Population-Based Outcomes Study Using a Health Information Exchange (HIE): Demographic Comparison of Groups (P07.047). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Judd S, Le A, Kleindorfer D, Gutierrez O, Muntner P, Kissela B, Unverzagt F, Jenny N, Wadley V. Vitamin D Intake: A Novel Neuroprotectant? (P07.052). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kelley B, Sucharew H, Alwell K, Moomaw C, Rademacher E, Embi P, Khoury J, Lindsell C, Woo D, Flaherty M, Khatri P, Adeoye O, Ferioli S, Kleindorfer D, Kissela B. Persistent Depression after Acute Stroke Predicts Dementia (P07.048). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Natarajan N, Khoury J, Moomaw C, Miller R, Sailor-Smith S, Frankel M, Kleindorfer D. The Beautyshop Stroke Education Project: The Physician's Office Is an Accurate Source for Stroke Knowledge among African-American Women (P04.063). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mullen M, Kasner S, Kallan M, Kleindorfer D, Albright K, Carr B. Joint Commission Primary Stroke Center Certification Increases rt-PA Treatment (PD2.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd2.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rhodes J, Aduroja O, Judd S, Kleindorfer D, Kissela B, Safford M, Anderson A, Howard V, Howard G. Do Demographic Disparities in Neuroimaging Utilization Exist in Stroke? The REGARDS Experience (S13.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s13.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Khatri P, Meganathan K, Adeoye O, Hornung R, Kleindorfer D. Acute Ischemic Stroke Treatment with Mechanical Embolectomy Has Doubled in the US from 2008 to 2010 (S09.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Khatri P, Meganathan K, Adeoye O, Hornung R, Kleindorfer D. Acute Ischemic Stroke Treatment with Mechanical Embolectomy Has Doubled in the US from 2008 to 2010 (IN2-1.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in2-1.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kelley B, Sucharew H, Alwell K, Moomaw C, Rademacher E, Embi P, Khoury J, Lindsell C, Woo D, Flaherty M, Khatri P, Adeoye O, Ferioli S, Kleindorfer D, Kissela B. Cognitive Outcome after Acute Stroke Does Not Correlate with Functional Outcome on Modified Rankin Scale (S53.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s53.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kernan W, Viscoli C, Brass L, Amatangelo M, Birch A, Clark W, Conwit R, Furie K, Gorman M, Pesapane B, Kleindorfer D, Lovejoy A, Osborne J, Silliman S, Zweifler R, Horwitz R. Boosting enrolment in clinical trials: validation of a regional network model. Clin Trials 2011; 8:645-53. [PMID: 21824978 PMCID: PMC3852692 DOI: 10.1177/1740774511414925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials of stroke therapy have been hampered by slow rates of enrolment. PURPOSE Our purpose is to validate a previously developed model for accelerating enrolment in clinical trials by replicating it at new locations. The model employs coordinators who travel from a host institution to enrol participants from a network of participating hospitals. Active surveillance assures identification of all eligible patients. METHODS Among 70 U.S. investigators participating in National Institutes of Health-funded trial of stroke prevention, five investigators were invited to develop local identification and outreach networks (LIONs). Each LION comprised a LION coordinating centre servicing multiple hospitals. Hospitals provided names of patients with stroke or transient ischaemic attack to researchers at the LION coordinating centre who initiated contact; patients were offered home visits for consent and randomization. Outcomes were feasibility, enrolment, data quality, and cost. RESULTS Five LIONs varied in size from two to eight hospitals. All 24 hospitals we approached agreed to participate. The average monthly rate of enrolment at the research sites increased from 1.4 participants to 3.5 after expanding from a single institution model to the LION format (mean change = 2.1, range 0.9-3.7). Monthly performance improved over time. Data quality was similar for LIONs and non-LION sites, except for drug adherence which was lower at LIONs. The average cost to randomize and follow one participant during the study interval was 2.4 times the cost under the per-patient, cost-reimbursement strategy at non-LION sites. The cost ratio declined from 3.4 in year one to 1.8 in year two. LIMITATIONS The LION strategy requires unprecedented collaboration and trust among institutions. Applicability beyond stroke requires confirmation. CONCLUSION LIONs are a practical, reproducible method to increase enrolment in trial research. Twelve months were required for the average site to reach its potential. The per-participant cost at LIONs was higher than conventional sites but declined over time.
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Affiliation(s)
- W Kernan
- IRIS Coordinating Center, Suite 515, 2 Church Street South, New Haven, CT 06519, USA.
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Mackey J, Kleindorfer D, Sucharew H, Moomaw CJ, Kissela BM, Alwell K, Flaherty ML, Woo D, Khatri P, Adeoye O, Ferioli S, Khoury JC, Hornung R, Broderick JP. Population-based study of wake-up strokes. Neurology 2011; 76:1662-7. [PMID: 21555734 DOI: 10.1212/wnl.0b013e318219fb30] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Previous studies have estimated that wake-up strokes comprise 8%to 28% of all ischemic strokes, but these studies were either small or not population-based. We sought to establish the proportion and event rate of wake-up strokes in a large population-based study and to compare patients who awoke with stroke symptoms with those who were awake at time of onset. METHODS First-time and recurrent ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky region (population 1.3 million) in 2005 were identified using International Classification of Diseases-9 codes 430-436 and verified via study physician review. Ischemic strokes in patients aged 18 years and older presenting to an emergency department were included. Baseline characteristics were ascertained, along with discharge modified Rankin Scale scores and 90-day mortality. RESULTS We identified 1,854 ischemic strokes presenting to an emergency department, of which 273 (14.3%) were wake-up strokes. There were no differences between wake-up strokes and all other strokes with regard to clinical features or outcomes except for minor differences in age and baseline retrospective NIH Stroke Scale score. The adjusted wake-up stroke event rate was 26.0/100,000. Of the wake-up strokes, at least 98 (35.9%) would have been eligible for thrombolysis if arrival time were not a factor. CONCLUSIONS Within our population, approximately 14% of ischemic strokes presenting to an emergency department were wake-up strokes. Wake-up strokes cannot be distinguished from other strokes by clinical features or outcome. We estimate that approximately 58,000 patients with wake-up strokes presented to an emergency department in the United States in 2005.
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Affiliation(s)
- J Mackey
- University of Cincinnati, Department of Neurology, Cincinnati, OH 45219, USA.
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Lisabeth LD, Kleindorfer D. Stroke literacy in high-risk populations: A call for action. Neurology 2009; 73:1940-1. [DOI: 10.1212/wnl.0b013e3181c51aa3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Flaherty ML, Tao H, Haverbusch M, Sekar P, Kleindorfer D, Kissela B, Khatri P, Stettler B, Adeoye O, Moomaw CJ, Broderick JP, Woo D. Warfarin use leads to larger intracerebral hematomas. Neurology 2008; 71:1084-9. [PMID: 18824672 DOI: 10.1212/01.wnl.0000326895.58992.27] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Among patients with intracerebral hemorrhage (ICH), warfarin use before onset leads to greater mortality. In a retrospective study, we sought to determine whether warfarin use is associated with larger initial hematoma volume, one determinant of mortality after ICH. METHODS We identified all patients hospitalized with ICH in the Greater Cincinnati region from January through December 2005. ICH volumes were measured on the first available brain scan by using the abc/2 method. Univariable analyses and a multivariable generalized linear model were used to determine whether international normalized ratio (INR) influenced initial ICH volume after adjusting for other factors, including age, race, sex, antiplatelet use, hemorrhage location, and time from stroke onset to scan. RESULTS There were 258 patients with ICH, including 51 patients taking warfarin. In univariable comparison, when INR was stratified, there was a trend toward a difference in hematoma volume by INR category (INR <1.2, 13.4 mL; INR 1.2-2.0, 9.3 mL; INR 2.1-3.0, 14.0 mL; INR >3.0, 33.2 mL; p = 0.10). In the model, compared with patients with INR <1.2, there was no difference in hematoma size for patients with INR 1.2-2.0 (p = 0.25) or INR 2.1-3.0 (p = 0.36), but patients with INR >3.0 had greater hematoma volume (p = 0.02). Other predictors of larger hematoma size were ICH location (lobar compared with deep cerebral, p = 0.02) and shorter time from stroke onset to scan (p < 0.001). CONCLUSION Warfarin use was associated with larger initial intracerebral hemorrhage (ICH) volume, but this effect was only observed for INR values >3.0. Larger ICH volume among warfarin users likely accounts for part of the excess mortality in this group.
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Affiliation(s)
- M L Flaherty
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH 45267-0525, USA.
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Pierre R, Lindsell C, Kissela B, Alwell K, Broderick J, Woo D, Flaherty M, Kleindorfer D. 391: Emergency Department Stroke Care is Similar by Race and Type of Hospital Within a Regional Population. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Flaherty ML, Karlawish J, Khoury JC, Kleindorfer D, Woo D, Broderick JP. How important is surrogate consent for stroke research? Neurology 2008; 71:1566-71. [DOI: 10.1212/01.wnl.0000316196.63704.f5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Adeoye O, Kleindorfer D, Lindsell C, Alwell K, Flaherty M, Woo D, Moomaw C, Kissela B. Emergency Medical Services Utilization By Stroke Patients: A Population-based Study. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Stettler B, Lindsell C, Alwell K, Kleindorfer D, Flaherty M, Woo D, Moomaw C, Broderick J, Kissela B. Frequency of Abnormal Lab Values in Patients Presenting to the Emergency Department with Acute Ischemic Stroke. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Stettler B, Lindsell C, Alwell K, Kleindorfer D, Flaherty M, Woo D, Moomaw C, Broderick J, Kissela B. Stroke Severity at Presentation to the Emergency Department Varies by Time of Day: Results of a Population-based Study. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Flaherty ML, Kissela B, Woo D, Kleindorfer D, Alwell K, Sekar P, Moomaw CJ, Haverbusch M, Broderick JP. The increasing incidence of anticoagulant-associated intracerebral hemorrhage. Neurology 2007; 68:116-21. [PMID: 17210891 DOI: 10.1212/01.wnl.0000250340.05202.8b] [Citation(s) in RCA: 300] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To define temporal trends in the incidence of anticoagulant-associated intracerebral hemorrhage (AAICH) during the 1990s and relate them to rates of cardioembolic ischemic stroke. METHODS We identified all patients hospitalized with first-ever intracerebral hemorrhage (ICH) in greater Cincinnati during 1988, from July 1993 through June 1994, and during 1999. AAICH was defined as ICH in patients receiving warfarin or heparin. Patients from the same region hospitalized with first-ever ischemic stroke of cardioembolic mechanism were identified during 1993/1994 and 1999. Incidence rates were calculated and adjusted to the 2000 US population. Estimates of warfarin distribution in the United States were obtained for the years 1988 through 2004. RESULTS AAICH occurred in 9 of 184 ICH cases (5%) in 1988, 23 of 267 cases (9%) in 1993/1994, and 54 of 311 cases (17%) in 1999 (p < 0.001). The annual incidence of AAICH per 100,000 persons was 0.8 (95% CI 0.3 to 1.3) in 1988, 1.9 (1.1 to 2.7) in 1993/1994, and 4.4 (3.2 to 5.5) in 1999 (p < 0.001 for trend). Among persons aged > or =80, the AAICH rate increased from 2.5 (0 to 7.4) in 1988 to 45.9 (25.6 to 66.2) in 1999 (p < 0.001 for trend). Incidence rates of cardioembolic ischemic stroke were similar in 1993/1994 and 1999 (31.1 vs 30.4, p = 0.65). Warfarin distribution in the United States quadrupled on a per-capita basis between 1988 and 1999. CONCLUSIONS The incidence of anticoagulant-associated intracerebral hemorrhage quintupled in our population during the 1990s. The majority of this change can be explained by increasing warfarin use. Anticoagulant-associated intracerebral hemorrhage now occurs at a frequency comparable to subarachnoid hemorrhage.
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Affiliation(s)
- M L Flaherty
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0525, USA.
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Flaherty ML, Haverbusch M, Sekar P, Kissela B, Kleindorfer D, Moomaw CJ, Sauerbeck L, Schneider A, Broderick JP, Woo D. Long-term mortality after intracerebral hemorrhage. Neurology 2006; 66:1182-6. [PMID: 16636234 DOI: 10.1212/01.wnl.0000208400.08722.7c] [Citation(s) in RCA: 289] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To characterize long-term mortality following intracerebral hemorrhage (ICH) in two large population-based cohorts assembled more than a decade apart. METHODS All patients age > or = 18 hospitalized with nontraumatic ICH in the Greater Cincinnati/Northern Kentucky area were identified during 1988 (Cohort 1) and from May 1998 to July 2001 and August 2002 to April 2003 (Cohort 2). Mortality was tabulated using actuarial methods and compared with a log-rank test. RESULTS There were 183 patients with ICH in Cohort 1 and 1,041 patients in Cohort 2. Patients in Cohort 1 were more likely to be white (p = 0.024) and undergo operation for their ICH (p = 0.002), whereas patients in Cohort 2 were more commonly on anticoagulants (p < 0.001). Among patients in Cohort 1, mortality at 7 days, 1 year, and 10 years was 31, 59, and 82%. Among patients in Cohort 2, mortality at 7 days and 1 year was 34 and 53%. Mortality rates did not differ between cohorts by log-rank test (p = 0.259). CONCLUSIONS Intracerebral hemorrhage (ICH) mortality did not improve significantly between study periods. Operation for ICH became less frequent, whereas anticoagulant-associated ICH became more common.
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Affiliation(s)
- M L Flaherty
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH 45267-0525, USA.
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Foroud T, Siemers E, Kleindorfer D, Bill DJ, Hodes ME, Norton JA, Conneally PM, Christian JC. Cognitive scores in carriers of Huntington's disease gene compared to noncarriers. Ann Neurol 1995; 37:657-64. [PMID: 7755361 DOI: 10.1002/ana.410370516] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Huntington's disease (HD) is a progressive neurodegenerative disorder recently shown to be due to an excess number of CAG trinucleotide repeats in the 5' translated region of chromosome 4. One of the cardinal features of HD is cognitive decline. While mental deterioration is obvious later in the disease course, the time of its onset is difficult to determine precisely. A sample of at-risk individuals without signs or symptoms of HD by self-report was studied. The Wechsler Adult Intelligence Test--Revised and a neurological rating scale were administered. The genotypes of 394 individuals were then determined by polymerase chain reaction testing. On all portions of the WAIS-R test, the mean score of the HD gene carriers was lower than that of the noncarriers. Scores on two of the performance subtests, the digit symbol and the picture arrangement, were significantly different in the two groups, even after the scores from all gene carriers who were diagnosed as affected based on their neurological motor examination were removed. The scores for the gene carriers on the various subtests were negatively correlated with the number of CAG repeats in the expanded HD allele. Such a relationship was not seen with the normal alleles of the noncarriers. Taken together, our results suggest that a deficit in cognitive function is an early finding of HD and that in this patient population, the degree of cognitive deficit is proportional to the number of CAG repeats in the HD allele.
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Affiliation(s)
- T Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis 46202, USA
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