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Navi BB, Bach I, Czap AL, Wang M, Yamal JM, Jacob AP, Parker SA, Rajan SS, Mir S, Sherman C, Willey JZ, Saver JL, Gonzalez MO, Singh N, Jones WJ, Ornelas D, Gonzales NR, Alexandrov AW, Alexandrov AV, Nour M, Spokoyny I, Mackey J, Collins SQ, Silnes K, Fink ME, English J, Barazangi N, Bratina PL, Volpi J, Rao CPV, Griffin L, Persse D, Grotta JC. Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units. Ann Neurol 2024; 95:347-361. [PMID: 37801480 DOI: 10.1002/ana.26816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 02/20/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE This study was undertaken to examine averted stroke in optimized stroke systems. METHODS This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue-defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis. RESULTS Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue-defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue-defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13-2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12-2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue-defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution. INTERPRETATION In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2024;95:347-361.
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Affiliation(s)
- Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Ivo Bach
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX
| | - Alexandra L Czap
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX
| | - Mengxi Wang
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX
| | - Asha P Jacob
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX
| | | | - Suja S Rajan
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX
| | - Saad Mir
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Carla Sherman
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Joshua Z Willey
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Jeffrey L Saver
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Michael O Gonzalez
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX
| | - Noopur Singh
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX
| | | | - David Ornelas
- Department of Neurology, University of Colorado, Aurora, CO
| | | | - Anne W Alexandrov
- Department of Neurology, College of Nursing and College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Andrei V Alexandrov
- Department of Neurology, University of Arizona, Banner University Medical Center, Phoenix, AZ
| | - May Nour
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Ilana Spokoyny
- Department of Neurology, Mills Peninsula Medical Center, Burlingame, CA
| | - Jason Mackey
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
| | - Sarah Q Collins
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
| | - Kelly Silnes
- University of Buckingham Medical School, Buckingham, UK
| | - Mathew E Fink
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Joey English
- Department of Neurology, Mills Peninsula Medical Center, Burlingame, CA
| | - Nobl Barazangi
- Department of Neurology, Mills Peninsula Medical Center, Burlingame, CA
| | - Patti L Bratina
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX
| | - Jay Volpi
- Department of Neurology, Houston Methodist Hospital, Houston, TX
| | - Chethan P V Rao
- Department of Neurology, Baylor College of Medicine, Houston, TX
| | | | - David Persse
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - James C Grotta
- Clinical Innovation and Research Institute, Memorial Hermann Hospital-Texas Medical Center, Houston, TX
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2
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Pirlog BO, Jacob AP, Rajan SS, Yamal JM, Parker SA, Wang M, Bowry R, Czap A, Bratina PL, Gonzalez MO, Singh N, Zou J, Gonzales NR, Jones WJ, Alexandrov AW, Alexandrov AV, Navi BB, Nour M, Spokoyny I, Mackey J, Silnes K, Fink ME, Pisarro Sherman C, Willey J, Saver JL, English J, Barazangi N, Ornelas D, Volpi J, Pv Rao C, Griffin L, Persse D, Grotta JC. Outcomes of patients with pre-existing disability managed by mobile stroke units: A sub-analysis of the BEST-MSU study. Int J Stroke 2023; 18:1209-1218. [PMID: 37337357 DOI: 10.1177/17474930231185471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients. AIM To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients. METHODS Primary outcomes were utility-weighted modified Rankin Scale (uw-mRS). Linear and logistic regression models compared outcomes in patients with versus without PD, and PD patients treated by MSU versus standard management by EMS. Time metrics, safety, quality of life, and health-care utilization were compared. RESULTS Of the 1047 tPA-eligible ischemic stroke patients, 254 were with PD (baseline mRS 2-5) and 793 were without PD (baseline mRS 0-1). Although PD patients had worse 90-day uw-mRS, higher mortality, more health-care utilization, and worse quality of life than non-disabled patients, 53% returned to at least their baseline mRS, those treated faster had better outcome, and there was no increased bleeding risk. Comparing PD patients treated by MSU versus EMS, 90-day uw-mRS was 0.42 versus 0.36 (p = 0.07) and 57% versus 46% returned to at least their baseline mRS. There was no interaction between disability status and MSU versus EMS group assignment (p = 0.67) for 90-day uw-mRS. CONCLUSION PD did not prevent the benefit of faster treatment with tPA in the BEST-MSU study. Our data support inclusion of PD patients in the MSU management paradigm.
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Affiliation(s)
- Bianca O Pirlog
- Department of Neuroscience, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Asha P Jacob
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephanie A Parker
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mengxi Wang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ritvij Bowry
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexandra Czap
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Patti L Bratina
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael O Gonzalez
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Noopur Singh
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jinhao Zou
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole R Gonzales
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William J Jones
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne W Alexandrov
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrei V Alexandrov
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Babak B Navi
- Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - May Nour
- Department of Neurology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ilana Spokoyny
- Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Jason Mackey
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kelly Silnes
- University of Buckingham Medical School, Buckingham, UK
| | - Matthew E Fink
- Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Carla Pisarro Sherman
- Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Josh Willey
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey L Saver
- Department of Neurology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Joey English
- Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Nobl Barazangi
- Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - David Ornelas
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jay Volpi
- Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Chethan Pv Rao
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | - David Persse
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James C Grotta
- Mobile Stroke Unit, Memorial Hermann Texas Medical Center, Houston, TX, USA
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3
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Messiah SE, Talebi Y, Swartz MD, Sabharwal R, Han H, Bergqvist E, Kohl HW, Valerio-Shewmaker M, DeSantis SM, Yaseen A, Kelder SH, Ross J, Padilla LN, Gonzalez MO, Wu L, Lakey D, Shuford JA, Pont SJ, Boerwinkle E. Long-term immune response to SARS-CoV-2 infection and vaccination in children and adolescents. Pediatr Res 2023:10.1038/s41390-023-02857-y. [PMID: 37875728 DOI: 10.1038/s41390-023-02857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND This analysis examined the durability of antibodies present after SARS-CoV-2 infection and vaccination in children and adolescents. METHODS Data were collected over 4 time points between October 2020-November 2022 as part of a prospective population-based cohort aged 5-to-19 years (N = 810). Results of the (1) Roche Elecsys® Anti-SARS-CoV-2 Immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein (Roche N-test); and (2) qualitative and semi-quantitative detection of antibodies to the SARS CoV-2 spike protein receptor binding domain (Roche S-test); and (3) self-reported antigen/PCR COVID-19 test results, vaccination and symptom status were analyzed. RESULTS N antibody levels reached a median of 84.10 U/ml (IQR: 20.2, 157.7) cutoff index (COI) ~ 6 months post-infection and increased slightly to a median of 85.25 (IQR: 28.0, 143.0) COI at 12 months post-infection. Peak S antibody levels were reached at a median of 2500 U/mL ~6 months post-vaccination and remained for ~12 months (mean 11.6 months, SD 1.20). CONCLUSIONS This analysis provides evidence of robust durability of nucleocapsid and spike antibodies in a large pediatric sample up to 12 months post-infection/vaccination. This information can inform pediatric SARS-CoV-2 vaccination schedules. IMPACT This study provided evidence of robust durability of both nucleocapsid and spike antibodies in a large pediatric sample up to 12 months after infection. Little is known about the long-term durability of natural and vaccine-induced SARS-CoV-2 antibodies in the pediatric population. Here, we determined the durability of anti-SARS-CoV-2 spike (S-test) and nucleocapsid protein (N-test) in children/adolescents after SARS-CoV-2 infection and/or vaccination lasts at least up to 12 months. This information can inform future SARS-CoV-2 vaccination schedules in this age group.
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Affiliation(s)
- Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA.
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX, USA.
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA.
| | - Yashar Talebi
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Rachit Sabharwal
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Haoting Han
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Emma Bergqvist
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX, USA
| | - Harold W Kohl
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Science Center at Houston, School of Public Health in Austin, Austin, TX, USA
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Melissa Valerio-Shewmaker
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health in Brownville, Brownsville, TX, USA
| | - Stacia M DeSantis
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Ashraf Yaseen
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Steven H Kelder
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Science Center at Houston, School of Public Health in Austin, Austin, TX, USA
| | - Jessica Ross
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Lindsay N Padilla
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Michael O Gonzalez
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Leqing Wu
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - David Lakey
- University of Texas System, Austin, TX, USA
- The University of Texas Health Science Center Tyler, Tyler, TX, USA
| | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, TX, USA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
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4
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Messiah SE, Swartz MD, Abbas RA, Talebi Y, Kohl HW, Valerio-Shewmaker M, DeSantis SM, Yaseen A, Kelder SH, Ross JA, Padilla LN, Gonzalez MO, Wu L, Lakey D, Shuford JA, Pont SJ, Boerwinkle E. SARS-CoV-2 Serostatus and COVID-19 Illness Characteristics by Variant Time Period in Non-Hospitalized Children and Adolescents. Children (Basel) 2023; 10:children10050818. [PMID: 37238366 DOI: 10.3390/children10050818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To describe COVID-19 illness characteristics, risk factors, and SARS-CoV-2 serostatus by variant time period in a large community-based pediatric sample. DESIGN Data were collected prospectively over four timepoints between October 2020 and November 2022 from a population-based cohort ages 5 to 19 years old. SETTING State of Texas, USA. PARTICIPANTS Participants ages 5 to 19 years were recruited from large pediatric healthcare systems, Federally Qualified Healthcare Centers, urban and rural clinical practices, health insurance providers, and a social media campaign. EXPOSURE SARS-CoV-2 infection. MAIN OUTCOME(S) AND MEASURE(S) SARS-CoV-2 antibody status was assessed by the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein (Roche N-test). Self-reported antigen or PCR COVID-19 test results and symptom status were also collected. RESULTS Over half (57.2%) of the sample (N = 3911) was antibody positive. Symptomatic infection increased over time from 47.09% during the pre-Delta variant time period, to 76.95% during Delta, to 84.73% during Omicron, and to 94.79% during the Omicron BA.2. Those who were not vaccinated were more likely (OR 1.71, 95% CI 1.47, 2.00) to be infected versus those fully vaccinated. CONCLUSIONS Results show an increase in symptomatic COVID-19 infection among non-hospitalized children with each progressive variant over the past two years. Findings here support the public health guidance that eligible children should remain up to date with COVID-19 vaccinations.
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Affiliation(s)
- Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in Dallas, The University of Texas (UT) Health Science Center at Houston, Dallas, TX 77030, USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX 75207, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX 77030, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Rhiana A Abbas
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Yashar Talebi
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Harold W Kohl
- School of Public Health in Austin, The University of Texas Health Science Center at Houston, Austin, TX 78701, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas at Austin, Austin, TX 78705, USA
| | - Melissa Valerio-Shewmaker
- School of Public Health in Brownville, The University of Texas Health Science Center at Houston, Brownsville, TX 78520, USA
| | - Stacia M DeSantis
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Ashraf Yaseen
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Steven H Kelder
- School of Public Health in Austin, The University of Texas Health Science Center at Houston, Austin, TX 78701, USA
| | - Jessica A Ross
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Lindsay N Padilla
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Michael O Gonzalez
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Leqing Wu
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - David Lakey
- Administration Division, University of Texas System, Austin, TX 78701, USA
- Department of Medicine, The University of Texas Health Science Center Tyler, Tyler, TX 75708, USA
| | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, TX 78711, USA
| | - Eric Boerwinkle
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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5
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Bach I, Czap AL, Parker SA, Jacob AP, Mir S, Wang M, Yamal JM, Rajan SS, Saver JL, Gonzalez MO, Singh N, Jones W, Alexandrov AW, Alexandrov AV, Nour M, Spokoyny I, Mackey J, Fink ME, English J, Barazangi N, Volpi JJ, Venkatasubba Rao CP, Kass JS, Griffin LJ, Persse D, Grotta JC, Navi BB. Abstract WP6: Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of the BEST-MSU Trial. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
While the goal of IV tissue plasminogen activator (TPA) is to prevent infarction, few data exist on averted stroke.
Methods:
Secondary analysis of a multicenter trial from 2014-2020 comparing outcomes between patients treated for stroke by mobile stroke unit (MSU) vs standard care (SC). The analytical cohort were patients with suspected stroke treated with IV TPA. The primary outcome was a time-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours. The secondary outcome was a tissue-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours and no acute infarction/hemorrhage on imaging. We used multivariable logistic regression to evaluate associations between study exposures (demographics, comorbidities, stroke characteristics) and outcomes.
Results:
Among 1009 patients with a median last known well-to-TPA time of 87 minutes, 276 patients (27%) had a time-defined averted stroke (31% MSU, 21% SC) and 159 patients (16%) had a tissue-defined averted stroke (18% MSU, 11% SC). Factors independently associated with time-defined averted stroke were younger age (OR, 0.98; 95% CI, 0.96-0.99), female sex (0R, 0.51; 95% CI, 0.36-0.74), hyperlipidemia (OR, 1.81, 95% CI, 1.24-2.64), normal premorbid function (0R, 2.22; 95% CI, 1.37-3.67), lower glucose (OR, 0.996; 95% CI, 0.993-0.999), lower MAP (OR, 0.991; 95% CI, 0.983-0.998), MSU care (OR, 1.77; 95% CI, 1.21-2.62), lower NIH stroke scale (OR, 0.89; 95% CI, 0.86-0.93), and no large vessel occlusion (LVO) (OR, 0.52; 95% CI, 0.32-0.83). For tissue-based averted stroke, younger age, female sex, hyperlipidemia, lower MAP, MSU treatment, lower NIH stroke scale, and no LVO were significantly associated.
Conclusion:
In a modern acute stroke trial, one-in-four patients treated with TPA for stroke recovered within 24 hours and one-in-six had no demonstrable brain injury on imaging. Younger age, female sex, hyperlipidemia, lower MAP, MSU care, lower stroke severity, and no LVO may increase the odds of averting stroke.
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Affiliation(s)
- Ivo Bach
- Neurology, UTHealth McGovern Med Sch, Houston, TX
| | | | | | | | - Saad Mir
- Weill Cornell Medicine, New York, NY
| | - Mengxi Wang
- Univ of Texas Sch of Public Health, Houston, TX
| | | | | | | | - Michael O. Gonzalez
- Dept of Biostatistics and Data Science, Univ of Texas Sch of Public Health, Houston, TX
| | - Noopur Singh
- Univ of Texas Health Sch of Public Health, Houston, TX
| | | | | | | | - May Nour
- Ronald Reagan UCLA Med Cntr, Los Angeles, CA
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6
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Pirlog BO, Jacob AP, Yamal JM, Parker S, Rajan SS, Bowry R, Czap AL, Bratina P, Gonzalez MO, Singh N, Wang M, Zou J, Gonzales NR, Jones WJ, Alexandrov AW, Alexandrov AV, Navi BB, Nour M, Spokoyny I, Mackey JS, Fink ME, Saver JL, English JD, Barazangi N, Volpi JJ, Rao CP, Kass JS, Griffin L, Persse D, Grotta JC. Abstract WMP2: Acute Stroke Treatment In Patients With Pre-exiting Disability: A Secondary Analysis Of The BEST-MSU Trial. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wmp2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Few data exists on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials.
Methods:
A pre-specified subgroup analysis of tPA-eligible patients with PD enrolled in a prospective multicenter trial of Mobile Stroke Units (MSUs) vs standard management by emergency medical services (EMS). All patients had baseline mRS scores. Co-primary outcomes were mean utility-weighted modified Rankin Scale score (uw-mRS) and return to baseline mRS at 90 days. Linear and logistic regression models compared outcomes in patients with vs without PD, and patients with PD treated by MSU vs EMS. Time metrics, safety, quality of life, and health-care utilization were also compared.
Results:
Of 1047 patients, 254 had baseline mRS
>=
2 (159 MSU, 95 EMS; 31% mRS 2, 52% mRS 3, 17% mRS 4). Compared to patients without disability, patients with PD were older, had higher NIHSS, more comorbidities, less often lived at home, were treated slower, and had less thrombectomy. Patients with PD had worse 90-day uw-mRS (0.39 vs 0.80), higher mortality, more health-care utilization and worse quality of life than patients without PD. However, rates of symptomatic intracranial hemorrhage and final diagnoses of stroke mimics were similar between groups, and 52% of patients with PD returned to their baseline mRS. Patients with PD treated within the first hour had better 90-day uw-mRS than those treated later (0.48 vs 0.36, p=0.01). Comparing patients with PD treated by MSU vs EMS, time from last-known-well to tPA bolus was shorter (82 vs 111 min), and 24% vs 0% were treated in the first hour. Among patients with PD, MSU patients had non-significantly better 90-day uw-mRS (0.41 vs 0.35, p=0.09) and higher rate of returning to baseline mRS (56% vs 44%, p=0.09) than EMS patients. There was no interaction between either time to treatment (p=0.24) or MSU vs EMS group assignment (p= 0.42), 90-day uw-mRS, and PD vs no disability status.
Conclusion:
Although outcomes after stroke are less favorable in patients with vs without PD, in a large, controlled trial, we found no interaction between baseline disability and the benefit of MSU treatment. Our data support the earliest treatment of acute stroke patients regardless of premorbid functional status.
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Affiliation(s)
- Bianca O Pirlog
- County Emergency Hosp, Dept of Neuroscience, Cluj-Napoca, Romania
| | - Asha P Jacob
- Univ of Texas Health Science Cntr at Houston McGovern Med Sch, Dept of Neurology, Houston, TX
| | - Jose-Miguel Yamal
- Univ of Texas Sch of Public Health, Dept of Biostatistics and Data Sciences, Houston, TX
| | - Stephanie Parker
- Univ of Texas Health Science Cntr at Houston McGovern Med Sch, Dept of Neurology, Houston, TX
| | - Suja S Rajan
- Univ of Texas Sch of Public Health, Dept of Management, Policy and Community Health, Houston, TX
| | - Ritvij Bowry
- Univ of Texas Health Science Cntr at Houston McGovern Med Sch, Dept of Neurosurgery, Houston, TX
| | - Alexandra L Czap
- Univ of Texas Health Science Cntr at Houston McGovern Med Sch, Dept of Neurology, Houston, TX
| | - Patti Bratina
- Univ of Texas Health Science Cntr at Houston McGovern Med Sch, Dept of Neurology, Houston, TX
| | - Michael O Gonzalez
- Univ of Texas Sch of Public Health, Dept of Biostatistics and Data Sciences, Houston, TX
| | - Noopur Singh
- Univ of Texas Sch of Public Health, Dept of Biostatistics and Data Sciences, Houston, TX
| | - Mengxi Wang
- Univ of Texas Sch of Public Health, Dept of Biostatistics and Data Sciences, Houston, TX
| | - Jinhao Zou
- Univ of Texas MD Anderson Cancer Cntr, Dept of Biostatistics, Houston, TX
| | - Nicole R Gonzales
- Univ of Colorado - Anschutz Med Campus, Dept of Neurology, Aurora, CO
| | - William J Jones
- Univ of Colorado - Anschutz Med Campus, Dept of Neurology, Aurora, CO
| | - Anne W Alexandrov
- Univ of Tennessee Health Science Cntr College of Medicine, Dept of Neurology, Memphis, TN
| | - Andrei V Alexandrov
- Univ of Tennessee Health Science Cntr College of Medicine, Dept of Neurology, Memphis, TN
| | - Babak B Navi
- Weill Cornell Med College, Neurology and the Brain and Mind Rsch Institute, New York, NY
| | - May Nour
- Ronald Reagan Univ of California, Los Angeles Med Cntr, Dept of Neurology, Los Angeles, CA
| | - Ilana Spokoyny
- Mills-Peninsula Med Cntr, Dept of Neurology, Bulingame, CA
| | - Jason S Mackey
- Indiana Univ Sch of Medicine, Dept of Neurology, Indiana, IN
| | - Matthew E Fink
- New York-Presbyterian Hosp/Weill Cornell Med Cntr, Dept of Neurology, New York, NY
| | - Jeffrey L Saver
- Ronald Reagan Univ of California, Los Angeles Med Cntr, Dept of Neurology, Los Angeles, CA
| | - Joey D English
- Mills-Peninsula Med Cntr, Dept of Neurology, Bulingame, CA
| | - Nobl Barazangi
- Mills-Peninsula Med Cntr, Dept of Neurology, Bulingame, CA
| | - John J Volpi
- Houston Methodist Neurological Institute, Dept of Neurology, Houston, TX
| | - Chetan P Rao
- Baylor College of Medicine, Dept of Neurology, Houston, TX
| | - Joseph S Kass
- Harris Health-Ben-Taub General Hosp, Dept of Neurology, Houston, TX
| | | | - David Persse
- Univ of Texas Dept McGovern Med Sch,Dept of Emergency Medicine, Houston, TX
| | - James C Grotta
- Memorial Hermann Texas Med Cntr, Mobile Stroke Unit, Houston, TX
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7
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Messiah SE, DeSantis SM, Leon-Novelo LG, Talebi Y, Brito FA, Kohl HW, Valerio-Shewmaker MA, Ross JA, Swartz MD, Yaseen A, Kelder SH, Zhang S, Omega-Njemnobi OS, Gonzalez MO, Wu L, Boerwinkle E, Lakey DL, Shuford JA, Pont SJ. Durability of SARS-CoV-2 Antibodies From Natural Infection in Children and Adolescents. Pediatrics 2022; 149:185412. [PMID: 35301530 DOI: 10.1542/peds.2021-055505] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sarah E Messiah
- Center for Pediatric Population Health.,The University of Texas Health Science Center at Houston, School of Public Health in Dallas, Dallas,Texas.,Children's Health System of Texas, Dallas, Texas
| | - Stacia M DeSantis
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Luis G Leon-Novelo
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Yashar Talebi
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Frances A Brito
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Harold W Kohl
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, Texas.,The University of Texas System, Austin, Texas
| | - Melissa A Valerio-Shewmaker
- The University of Texas Health Science Center at Houston, School of Public Health in Brownsville, Brownsville, Texas
| | - Jessica A Ross
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Michael D Swartz
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Ashraf Yaseen
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Steven H Kelder
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, Texas
| | - Shiming Zhang
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Onyinye S Omega-Njemnobi
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, Texas
| | - Michael O Gonzalez
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Leqing Wu
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Eric Boerwinkle
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | | | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, Texas
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8
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Swartz MD, DeSantis SM, Yaseen A, Brito FA, Valerio-Shewmaker MA, Messiah SE, Leon-Novelo LG, Kohl HW, Pinzon-Gomez CL, Hao T, Zhang S, Talebi Y, Yoo J, Ross JR, Gonzalez MO, Wu L, Kelder SH, Silberman M, Tuzo S, Pont SJ, Shuford JA, Lakey D, Boerwinkle E. Antibody Duration After Infection From SARS-CoV-2 in the Texas Coronavirus Antibody Response Survey. J Infect Dis 2022; 227:193-201. [PMID: 35514141 PMCID: PMC9833436 DOI: 10.1093/infdis/jiac167] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 01/20/2023] Open
Abstract
Understanding the duration of antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes COVID-19 is important to controlling the current pandemic. Participants from the Texas Coronavirus Antibody Response Survey (Texas CARES) with at least 1 nucleocapsid protein antibody test were selected for a longitudinal analysis of antibody duration. A linear mixed model was fit to data from participants (n = 4553) with 1 to 3 antibody tests over 11 months (1 October 2020 to 16 September 2021), and models fit showed that expected antibody response after COVID-19 infection robustly increases for 100 days postinfection, and predicts individuals may remain antibody positive from natural infection beyond 500 days depending on age, body mass index, smoking or vaping use, and disease severity (hospitalized or not; symptomatic or not).
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Affiliation(s)
- Michael D Swartz
- Correspondence: Michael D. Swartz, PhD, Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030 ()
| | - Stacia M DeSantis
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Ashraf Yaseen
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Frances A Brito
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Melissa A Valerio-Shewmaker
- The University of Texas Health Science Center in Houston, School of Public Health in Brownsville, Brownsville, Texas, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center in Houston, School of Public Health in Dallas, Dallas, Texas, USA
| | - Luis G Leon-Novelo
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Harold W Kohl
- The University of Texas Health Science Center in Houston, School of Public Health in Austin, Austin, Texas, USA,The University of Texas at Austin, College of Education, Department of Kinesiology and Health Education, Austin, Texas, USA
| | - Cesar L Pinzon-Gomez
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Tianyao Hao
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Shiming Zhang
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Yashar Talebi
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Joy Yoo
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Jessica R Ross
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Michael O Gonzalez
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Leqing Wu
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Steven H Kelder
- The University of Texas Health Science Center in Houston, School of Public Health in Austin, Austin, Texas, USA
| | | | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, Texas, USA
| | | | - David Lakey
- University of Texas System, Office of Health Affairs, Austin, Texas, USA
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9
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Valerio-Shewmaker MA, DeSantis S, Swartz M, Yaseen A, Gonzalez MO, Kohl HWI, Kelder SH, Messiah SE, Aguillard KA, Breaux C, Wu L, Shuford J, Pont S, Lakey D, Boerwinkle E. Strategies to Estimate Prevalence of SARS-CoV-2 Antibodies in a Texas Vulnerable Population: Results From Phase I of the Texas Coronavirus Antibody Response Survey. Front Public Health 2022; 9:753487. [PMID: 34970525 PMCID: PMC8712464 DOI: 10.3389/fpubh.2021.753487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and immunity remains uncertain in populations. The state of Texas ranks 2nd in infection with over 2.71 million cases and has seen a disproportionate rate of death across the state. The Texas CARES project was funded by the state of Texas to estimate the prevalence of SARS-CoV-2 antibody status in children and adults. Identifying strategies to understand natural as well as vaccine induced antibody response to COVID-19 is critical. Materials and Methods: The Texas CARES (Texas Coronavirus Antibody Response Survey) is an ongoing prospective population-based convenience sample from the Texas general population that commenced in October 2020. Volunteer participants are recruited across the state to participate in a 3-time point data collection Texas CARES to assess antibody response over time. We use the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay to determine SARS-CoV-2 antibody status. Results: The crude antibody positivity prevalence in Phase I was 26.1% (80/307). The fully adjusted seroprevalence of the sample was 31.5%. Specifically, 41.1% of males and 21.9% of females were seropositive. For age categories, 33.5% of those 18–34; 24.4% of those 35–44; 33.2% of those 45–54; and 32.8% of those 55+ were seropositive. In this sample, 42.2% (89/211) of those negative for the antibody test reported having had a COVID-19 test. Conclusions: In this survey we enrolled and analyzed data for 307 participants, demonstrating a high survey and antibody test completion rate, and ability to implement a questionnaire and SARS-CoV-2 antibody testing within clinical settings. We were also able to determine our capability to estimate the cross-sectional seroprevalence within Texas's federally qualified community centers (FQHCs). The crude positivity prevalence for SARS-CoV-2 antibodies in this sample was 26.1% indicating potentially high exposure to COVID-19 for clinic employees and patients. Data will also allow us to understand sex, age and chronic illness variation in seroprevalence by natural and vaccine induced. These methods are being used to guide the completion of a large longitudinal survey in the state of Texas with implications for practice and population health.
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Affiliation(s)
| | - Stacia DeSantis
- School of Public Health, University of Texas Health Science Center, Brownsville, TX, United States
| | - Michael Swartz
- School of Public Health, University of Texas Health Science Center, Brownsville, TX, United States
| | - Ashraf Yaseen
- School of Public Health, University of Texas Health Science Center, Brownsville, TX, United States
| | - Michael O Gonzalez
- School of Public Health, University of Texas Health Science Center, Brownsville, TX, United States
| | - Harold W Iii Kohl
- School of Public Health, University of Texas Health Science Center, Austin, TX, United States.,Texas Department of State Health Services, Austin, TX, United States.,University of Texas System, Population Health, Austin, TX, United States
| | - Steven H Kelder
- School of Public Health, University of Texas Health Science Center, Austin, TX, United States.,Texas Department of State Health Services, Austin, TX, United States
| | - Sarah E Messiah
- School of Public Health, University of Texas Health Science Center, Dallas, TX, United States
| | - Kimberly A Aguillard
- School of Public Health, University of Texas Health Science Center, Brownsville, TX, United States.,School of Public Health, University of Texas Health Science Center, Dallas, TX, United States
| | - Camille Breaux
- School of Public Health, University of Texas Health Science Center, Brownsville, TX, United States.,School of Public Health, University of Texas Health Science Center, Dallas, TX, United States
| | - Leqing Wu
- School of Public Health, University of Texas Health Science Center, Brownsville, TX, United States.,School of Public Health, University of Texas Health Science Center, Dallas, TX, United States
| | - Jennifer Shuford
- Texas Department of State Health Services, Austin, TX, United States
| | - Stephen Pont
- Texas Department of State Health Services, Austin, TX, United States
| | - David Lakey
- University of Texas System, Population Health, Austin, TX, United States
| | - Eric Boerwinkle
- School of Public Health, University of Texas Health Science Center, Brownsville, TX, United States
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10
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Yamal JM, Rajan SS, Parker SA, Jacob AP, Gonzalez MO, Gonzales NR, Bowry R, Barreto AD, Wu TC, Lairson DR, Persse D, Tilley BC, Chiu D, Suarez JI, Jones WJ, Alexandrov A, Grotta JC. Benefits of stroke treatment delivered using a mobile stroke unit trial. Int J Stroke 2017; 13:321-327. [DOI: 10.1177/1747493017711950] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile stroke unit and standard management clinical outcomes, healthcare utilization, and cost-effectiveness in tissue plasminogen activator-eligible acute ischemic stroke patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 in mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective cluster-randomized (mobile stroke unit versus standard management weeks) comparative effectiveness study in tissue plasminogen activator-eligible patients. Outcomes Primary: Ninety-day mean utility-weighted modified Rankin scale. Coprimary: cost-effectiveness based on EQ5D quality of life and one year poststroke costs. Analysis Two-sample t-test and linear regression adjusting for covariates; incremental cost-effectiveness ratio and net benefit regression. Results As of March 2017, 288 tissue plasminogen activator-eligible patients have been enrolled (173 in the mobile stroke unit arm and 115 in the standard management arm). Two new centers start in early 2017 with target end of recruitment September 2019. Conclusion This is the first randomized study to test for disability, healthcare utilization, and cost-effectiveness of a mobile stroke unit. The progress of the study suggests that it is feasible. Management of tissue plasminogen activator eligible acute ischemic stroke patients by a mobile stroke unit could potentially result in less disability and healthcare utilization, and be cost effective. Mobile stroke units are very costly. This trial may determine if the fixed cost can be justified by a reduction in disability and healthcare utilization. Clinical Trial Registration NCT02190500.
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Affiliation(s)
- Jose-Miguel Yamal
- Department of Biostatistics, UTHealth School of Public Health, Houston, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, USA
| | - Stephanie A Parker
- Department of Neurology, McGovern Medical School at UTHealth, Houston, USA
| | - Asha P Jacob
- Department of Biostatistics, UTHealth School of Public Health, Houston, USA
| | - Michael O Gonzalez
- Department of Biostatistics, UTHealth School of Public Health, Houston, USA
| | - Nicole R Gonzales
- Department of Neurology, McGovern Medical School at UTHealth, Houston, USA
| | - Ritvij Bowry
- Department of Neurology, McGovern Medical School at UTHealth, Houston, USA
| | - Andrew D Barreto
- Department of Neurology, McGovern Medical School at UTHealth, Houston, USA
| | - Tzu-Ching Wu
- Department of Neurology, McGovern Medical School at UTHealth, Houston, USA
| | - David R Lairson
- Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, USA
| | - David Persse
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, USA
| | - Barbara C Tilley
- Department of Biostatistics, UTHealth School of Public Health, Houston, USA
| | - David Chiu
- Department of Neurology, Houston Methodist Hospital, Houston, USA
| | - Jose I Suarez
- Department of Neurology, Baylor College of Medicine, Houston, USA
| | - William J Jones
- Department of Neurology, University of Colorado School of Medicine, Aurora, USA
| | - Andrei Alexandrov
- Department of Neurology, Stroke Program, University of Tennessee, Memphis, USA
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11
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Abstract
A case of carcinoma originating in a diverticulum of the urethra in a female patient is presented. A review of 143 cases of carcinoma of the female urethra treated from 1948 to 1984 at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston disclosed 6 additional patients with diverticular carcinoma. Analysis of their clinical features, treatments--various combinations of primary excision, radiotherapy, and chemotherapy--and survival results indicate that survival is primarily a function of grade. Only 40 cases of carcinoma in urethral diverticula are recorded in the world literature. The majority are adenocarcinomas, and the most frequent presenting symptoms are dysuria, frequency, and urgency. Radiotherapy successfully established long-term control of the disease with low morbidity in all of our patients who had low-grade tumors.
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12
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Gonzalez MO, Drouilhet JH, Ruiz RS, Cundiff JH. Transparent plastic replicas of cobalt-60 applicators for the management of choroid tumors. Radiology 1981; 141:545. [PMID: 7291589 DOI: 10.1148/radiology.141.2.7291589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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