24 research outputs found
Delayed Diagnosis in Cerebral Venous Thrombosis: Associated Factors and Clinical Outcomes.
Background Identifying factors associated with delayed diagnosis of cerebral venous thrombosis (CVT) can inform future strategies for early detection. Methods and Results We conducted a retrospective cohort study including all participants from ACTION-CVT (Anticoagulation in the Treatment of Cerebral Venous Thrombosis) study who had dates of neurologic symptom onset and CVT diagnosis available. Delayed diagnosis was defined as CVT diagnosis occurring in the fourth (final) quartile of days from symptom onset. The primary study outcome was modified Rankin Scale score of â€1 at 90âdays; secondary outcomes included partial/complete CVT recanalization on last available imaging and modified Rankin Scale score of â€2. Logistic regression analyses were used to identify independent variables associated with delayed diagnosis and to assess the association of delayed diagnosis and outcomes. A total of 935 patients were included in our study. Median time from symptom onset to diagnosis was 4âdays (interquartile range, 1-10âdays). Delayed CVT diagnosis (time to diagnosis >10âdays) occurred in 212 patients (23%). Isolated headache (adjusted odds ratio [aOR], 2.36 [95% CI, 1.50-3.73]; P10âdays after symptom onset. Delayed CVT diagnosis was associated with the symptom of isolated headache and was not associated with adverse clinical outcomes
Letter by Liberman et al Regarding Article, âPsychiatric Hospitalization Increases Short-Term Risk of Strokeâ
Association Between Stroke Presentation During OffâHours and Mechanical Thrombectomy
Background Access to mechanical thrombectomy (MT) in the United States remains limited. Given potential staffing challenges, we hypothesized that access to thrombectomy would be worse off hours. Methods We used 2016 to 2018 allâpayer claims data from all nonfederal emergency departments and acute care hospitals across 11 US states encompassing 80 million residents. Using recorded arrival times, hospital presentation was classified as on hours if it fell between 8:00Â a.m. and 6:00Â p.m. on weekdays and as off hours otherwise. We examined the association between offâhours arrival and MT using multiple adjusted logistic regression models. In a subset of patients with available National Institutes of Health Stroke Scale data, we performed a sensitivity analysis limited to patients who presented to a thrombectomy hub with a probable largeâvessel occlusion, defined as a documented National Institutes of Health Stroke Scale score â„12, and underwent intravenous thrombolysis. Similar analyses were performed to assess MT odds during extreme off hours, defined as midnight to 6:00Â a.m., compared to 8:00Â a.m. to 2:00Â p.m. Results Among 169Â 199 patients with ischemic stroke, the 82Â 784 (48.9%) who presented during off hours more often presented to thrombectomy hubs and teaching hospitals and more often received intravenous thrombolysis. Among 31Â 148 patients with documented National Institutes of Health Stroke Scale scores, those presenting off hours had higher scores (4 [interquartile range, 2â10] versus 2 [interquartile range, 1â9]; P<0.001). There were no differences between groups in rates of MT (3.4% on hours versus 3.5% off hours; P=0.25). In adjusted models, offâhours presentation was not significantly associated with lower odds of MT (odds ratio [OR], 0.94; [95% CI, 0.85â1.03]). Our findings were similar in a sensitivity analysis limited to patients with a probable largeâvessel occlusion who initially presented to a thrombectomy hub and underwent intravenous thrombolysis (OR, 0.87; [95% CI, 0.69â1.09]). Extreme offâhours presentation was associated with a lower likelihood of MT (OR, 0.83; [95% CI, 0.75â0.93]). Conclusion In a large, populationâbased sample of ischemic stroke patients across the United States, the odds of MT were similar during on and off hours. Extreme off hours seem to be associated with decreased access to treatment
supplement_fig - Clinical Decision-Making for Thrombolysis of Acute Minor Stroke Using Adaptive Conjoint Analysis
<p>supplement_fig for Clinical Decision-Making for Thrombolysis of Acute Minor Stroke Using Adaptive Conjoint Analysis by Ava L. Liberman, Daniel Pinto, Sara K. Rostanski, Daniel L. Labovitz, Andrew M. Naidech, and Shyam Prabhakaran in The Neurohospitalist</p
Longâterm risk of seizure after posterior reversible encephalopathy syndrome
Abstract Objective Patients with posterior reversible encephalopathy syndrome (PRES) can develop seizures during the acute phase. We sought to determine the longâterm risk of seizure after PRES. Methods We performed a retrospective cohort study using statewide allâpayer claims data from 2016â2018 from nonfederal hospitals in 11 US states. Adults admitted with PRES were compared to adults admitted with stroke, an acute cerebrovascular disorder associated with longâterm risk of seizure. The primary outcome was seizure diagnosed during an emergency room visit or hospital admission after the index hospitalization. The secondary outcome was status epilepticus. Diagnoses were determined using previously validated ICDâ10âCM codes. Patients with seizure diagnoses before or during the index admission were excluded. We used Cox regression to evaluate the association of PRES with seizure, adjusting for demographics and potential confounders. Results We identified 2095 patients hospitalized with PRES and 341,809 with stroke. Median followâup was 0.9âyears (IQR, 0.3â1.7) in the PRES group and 1.0âyears (IQR, 0.4â1.8) in the stroke group. Crude seizure incidence per 100 personâyears was 9.5 after PRES and 2.5 after stroke. After adjustment for demographics and comorbidities, patients with PRES had a higher risk of seizure than patients with stroke (HR, 2.9; 95% CI, 2.6â3.4). Results were unchanged in a sensitivity analysis that applied a twoâweek washout period to mitigate detection bias. A similar relationship was observed for the secondary outcome of status epilepticus. Interpretation PRES was associated with an increased longâterm risk of subsequent acute care utilization for seizure compared to stroke