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Race and Income Disparity in Ischemic Stroke Care: Nationwide Inpatient Sample Database, 2002 to 2008
We examined whether patients of particular ethnicity or income levels experienced reduced access to or delays in receiving stroke care.Methods: We studied all admissions for ischemic stroke in the Nationwide Inpatient Sample (NIS) database between 2002 and 2008. We used statistical models to determine whether median income or race were associated with intravenous (IV) thrombolysis treatment, in-hospital mortality, discharge disposition, hospital charges, and LOS in high- or low-volume hospitals.Results: There were a total of 477,474 patients with ischemic stroke: 10,781 (2.3%) received IV thrombolysis, and 380,400 (79.7%) ...
Source: Journal of Stroke and Cerebrovascular Diseases - July 23, 2012 Category: Neurology Authors: Matthew M. Kimball, Dan Neal, Michael F. Waters, Brian L. Hoh Tags: Original Articles Source Type: research
Disparities in Acute Stroke Severity, Outcomes, and Care Relative to Health Insurance Status
Background: To examine the differences in risk factors and length of hospital stay (LOS) between the insured and uninsured stroke patients, identifying the root causes of increasing hospital stay.Methods: Retrospective analysis of stroke registry data of acute stroke patients (N = 19,255) was analyzed to compare risk factors, severity, outcome, and LOS by insurance status. Chart review of patients from a comprehensive stroke center (N = 3290) was studied in greater detail for causes of extended length of stay.Results: The uninsured patients had poorer control of risk factors and statistically significantly (P
Source: Journal of Stroke and Cerebrovascular Diseases - October 7, 2013 Category: Neurology Authors: Tefera Gezmu, Martin S. Gizzi, Jawad F. Kirmani, Dona Schneider, Mohammad Moussavi Tags: Original Articles Source Type: research
Translation of the ‘time is brain’ concept into clinical practice: Focus on prehospital stroke management
Acute stroke is one of the main causes of death and chronic disability. Thrombolysis with recombinant tissue plasminogen activator within the first hours after onset of symptoms is an effective therapeutic option for ischemic stroke. However, fewer than 2% to 7% of patients receive this treatment, primarily because most patients reach the hospital too late for the initiation of successful therapy. Several measures can reduce detrimental delay until treatment. It is of importance to use continual public awareness campaigns to reduce delays in patients' alarm of emergency medical services. Further relevant measures are repet...
Source: International Journal of Stroke - March 4, 2014 Category: Neurology Authors: A. Ragoschke‐Schumm, S. Walter, A. Haass, C. Balucani, M. Lesmeister, A. Nasreldein, L. Sarlon, A. Bachhuber, T. Licina, I. Q. Grunwald, K. Fassbender Tags: Review Source Type: research
Thrombolysis for Acute Ischemic Stroke: Do Patients Treated Out of Hours Have a Worse Outcome?
Introduction: Previous studies on the impact of nonworking hours (NWH) have produced conflicting results. We aimed to compare the time to treatment with thrombolysis between NWH and working hours (WH) at an Australian comprehensive stroke center.Materials and Methods: All acute ischemic stroke patients treated with intravenous alteplase (IV-alteplase) from January 2003 to December 2011 at the Royal Melbourne Hospital were included. Data collected included demographics, serial time points (including onset, presentation to emergency department, neuroimaging, and thrombolysis), and clinical outcomes (modified Rankin Scale [mR...
Source: Journal of Stroke and Cerebrovascular Diseases - April 30, 2013 Category: Neurology Authors: Kun Fang, Leonid Churilov, Louise Weir, Qiang Dong, Stephen Davis, Bernard Yan Tags: Original Articles Source Type: research
Socioeconomic Disparities in the Utilization of Mechanical Thrombectomy for Acute Ischemic Stroke
We examined the utilization rates of mechanical thrombectomy by race/ethnicity (white, black, Hispanic, and Asian/Pacific Islander), income quartile (first, second to third, and fourth), and insurance status (Medicare, Medicaid, self-pay, and private). We also studied thrombectomy utilization rates at hospitals that performed thrombectomy.Results: From 2006 to 2010, 2,087,017 patients were hospitalized with a primary diagnosis of acute ischemic stroke; 8946 patients (.4%) received mechanical thrombectomy. Compared with white patients, black patients had significantly lower rates of overall mechanical thrombectomy utilizati...
Source: Journal of Stroke and Cerebrovascular Diseases - October 10, 2013 Category: Neurology Authors: Waleed Brinjikji, Alejandro A. Rabinstein, Harry J. Cloft Tags: Original Articles Source Type: research
Abstract 11: Temporal Changes in NIHSS Documentation and Stroke Severity among Patients Treated with Thrombolysis in the Massachusetts Coverdell Registry Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics
Discussion: IV tPA use in MA Coverdell patients is increasing and now reaches 25% of all early arriving subjects. NIHSS documentation is increasing as well, especially among subjects with lower NIHSS scores. The median NIHSS in RISS or Too Mild patients is reassuringly low, and decreased significantly among Too Mild patients. These data, coupled with the fact that unadjusted rates of discharge home among IV tPA patients are increasing while severity-adjusted rates are not, suggests that more patients previously felt to be Too Mild are now receiving IV tPA. Further efforts are still warranted.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Schwamm, L., Parkinson, G., Coe, L. Tags: Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics Source Type: research
Burden of stroke in Puerto Rico
Stroke is the fifth leading cause of death and the first cause of long‐term disability in Puerto Rico. Trained staff reviewed and independently validated the medical records of patients who had been hospitalized with possible stroke at any of the 20 largest hospitals located in Puerto Rico during 2007, 2009, and 2011. The mean age of the 5005 newly diagnosed stroke patients (51·2% female) was 70 years. At the time of hospitalization, women were 4½ years older, were less likely to be married (60·2% vs. 39·9%, P < 0·001), smoked less (5·8% vs. 13·4%, P < 0·001), and had significantly higher proportion...
Source: International Journal of Stroke - August 1, 2014 Category: Neurology Authors: J. C. Zevallos, F. Santiago, J. González, A. Rodríguez, L. Pericchi, R. Rodríguez‐Mercado, U. Nobo Tags: Panorama Source Type: research
Earlier thrombolytic treatment is associated with better outcomes following acute ischaemic stroke
Commentary on Saver JL, Fonarow GC, Smith EE, et al.. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischaemic stroke, JAMA 2013;309:2480–8. Implications for practice and research Optimisation is necessary in public education and hospital triage of the identification of factors such as arrival by ambulance and the importance of requesting emergency medical services (EMS) at scene of the stroke occurrence.1 The results of previous studies suggest that a disparity, observed between hospital-based outcomes for admissions that presented during regular hours and off hours, is not se...
Source: Evidence-Based Nursing - September 15, 2014 Category: Nursing Authors: Ullah, N., Thompson, M. J., Qureshi, A. I. Tags: Adult nursing, Drugs: cardiovascular system, Stroke Source Type: research
Paramedics may be first line of treatment for stroke
There is no time to waste when it comes to stroke. The more time that passes between stroke onset and treatment, the worse the outcome is for the patient. A study designed to test the benefits of early administration of magnesium sulfate suggests that stroke patients may not have to wait until they get to the hospital for treatment — paramedics may be able to start therapy as soon as stroke is suspected.
Source: NINDS Press Releases and News: National Institute of Neurological Disorders and Stroke - February 4, 2015 Category: Neurology Source Type: news
Implementation of a Stroke Registry Is Associated with an Improvement in Stroke Performance Measures in a Tertiary Hospital in Mexico
Stroke registries provide a simple way for improving patient care, and its use has been associated with a better adherence to the published guidelines. Few Latin American countries had established stroke registries. Our study is the first in Mexico to report the effects of implementing a stroke registry. To determine if the implementation of a systematized registry is associated with an improved adherence to the performance measures.
Source: Journal of Stroke and Cerebrovascular Diseases - February 10, 2015 Category: Neurology Authors: Ana Lucia Herrera, Fernando Góngora-Rivera, Walter Muruet, Héctor Jorge Villarreal, Mildred Gutiérrez-Herrera, Lena Huerta, Diana Carrasco, Anally Soto-García, Meztli Espinosa-Ortega, GECEN Investigators Source Type: research
Weekend versus Weekday Admission and In-Hospital Mortality from Ischemic Stroke in Japan
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).
Source: Journal of Stroke and Cerebrovascular Diseases - September 10, 2015 Category: Neurology Authors: Takahiro Inoue, Kiyohide Fushimi Source Type: research
Pulse pressure and in-hospital outcome of acute ischemic stroke
We aimed to evaluate the association between pulse pressure, a readily available marker of arterial stiffness, and the in-hospital outcome of patients with acute ischemic stroke. We prospectively studied 790 consecutive patients who were admitted with acute ischemic stroke (41.0% males, age 79.4±6.8 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). The outcome was assessed with dependency rates at discharge (modified Rankin scale between 2 and 5) and with in-hospital mortality.
Source: Journal of the American Society of Hypertension - March 31, 2016 Category: Cardiology Authors: Konstantinos Tziomalos, Stella Bouziana, Marianna Spanou, Stavroula Kostaki, Stella-Maria Angelopoulou, Maria Papadopoulou, Vasilios Giampatzis, Maria Tsopozidi, Christos Savopoulos, Apostolos I. Hatzitolios Tags: Stroke Source Type: research
Moyamoya and childhood stroke: Catching up with Tyler and Ryan
Ryan (above left) and Tyler Earle of Winnipeg, Canada had a ticking time bomb inside their heads. Both boys have a rare brain disorder called moyamoya that had caused the arteries feeding their brains to become dangerously narrowed.
At first, they experienced only headaches. But then Ryan suddenly lost his ability to write, began having trouble with word-finding and became weak on one side of his body — signs he had suffered a stroke. He was diagnosed with moyamoya and had partial surgery, but a second stroke took away part of his vision and partially paralyzed him.
Ryan needed a second operation as soon as possible. By ...
Source: Thrive, Children's Hospital Boston - May 12, 2016 Category: Pediatrics Authors: Nancy Fliesler Tags: Diseases & Conditions Cerebrovascular Disorders and Stroke Program Dr. Edward Smith moyamoya Source Type: news
Telestroke: Solid support for virtual acute stroke care
IV recombinant tissue plasminogen activator (rtPA) within 4.5 hours of symptom onset has been established as an effective therapy for acute ischemic stroke.1 Over the past 2 decades, systems of care and quality assurance teams have developed to ensure that all potentially eligible patients receive IV rtPA in a timely and effective manner.2 Many neurologists cannot arrive rapidly to the emergency department for in-person acute stroke assessment, and many rural areas lack 24/7 coverage by neurologists. Telemedicine has brought neurologic expertise through real-time audiovisual technical link to the emergency department for a...
Source: Neurology - September 25, 2016 Category: Neurology Authors: Demaerschalk, B. M., Levine, S. R. Tags: Outcome research, All Cerebrovascular disease/Stroke, Clinical trials Systematic review/meta analysis EDITORIALS Source Type: research
Stroke-Associated Pneumonia Risk Score: Validity in a French Stroke Unit
Stroke-associated pneumonia is a leading cause of in-hospital death and post-stroke outcome. Screening patients at high risk is one of the main challenges in acute stroke units. Several screening tests have been developed, but their feasibility and validity still remain unclear.
Source: Journal of Stroke and Cerebrovascular Diseases - November 7, 2016 Category: Neurology Authors: Emmanuelle Cugy, Igor Sibon Source Type: research
