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ICU Interventions in Ischemic Stroke Patients Treated Using Liberalized IV-tPA Criteria
Background and Objective: Current standard practice guidelines recommend ICU admission for ischemic stroke patients treated with intravenous tissue plasminogen activator (IV-tPA). More recently, the trend in stroke care is to broaden eligibility for IV thrombolysis. Two examples are a more liberal inclusion criteria known as SMART criteria (sIV-tPA), and the transfer of patients to comprehensive stroke centers (CSC). The present study characterizes ICU interventions in these patients. Understanding which stroke patients that require ICU-level care may allow for placement of patients in the appropriate level of care at hospital admission.
Source: Journal of Stroke and Cerebrovascular Diseases - July 2, 2019 Category: Neurology Authors: Nick M. Murray, Michael Ke, Alan Yee, Charlene Chen, Christine Wong, Ann Bedenk, Julia Fernandes, Nobl Barazangi, David Tong Source Type: research
Use of Wearable Technology in Remote Evaluation of Acute Stroke Patients: Feasibility and Reliability of a Google Glass-Based Device
Background: Telestroke is an efficient, cost-effective way to standardize care and improve access to immediate neurologic expertise for rural hospitals and other underserved areas. Hands-free wearable technology potentially allows for faster evaluations that fit easily within prehospital workflows and could improve prehospital triage of stroke patients to appropriate receiving stroke centers. The goal of this study is to assess the feasibility and inter-rater reliability of wearable eyeglass video technology in assessing stroke-related neurologic deficits in patients with suspected acute stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - July 8, 2019 Category: Neurology Authors: Ali Reza Noorian, Mersedeh Bahr Hosseini, Gilda Avila, Richard Gerardi, Anne-Fleur Andrle, Michael Su, Sidney Starkman, Jeffrey L. Saver, Latisha K. Sharma Source Type: research
Timing of Direct Enteral Tube Placement and Outcomes after Acute Stroke
Background: Direct enteral feeding tube (DET) placement for dysphagia after stroke is associated with poor outcomes. However, the relationship between timing of DET placement and poststroke mortality and disability is unknown. We sought to determine the risk of mortality and severe disability in patients who receive DET at different times after stroke. Methods: We used the Ontario Stroke Registry and linked administrative databases to identify patients with acute ischemic stroke or intracerebral hemorrhage between 2003 and 2013 who received DET (gastrostomy or jejunostomy) during their hospital admission.
Source: Journal of Stroke and Cerebrovascular Diseases - September 27, 2019 Category: Neurology Authors: Raed A. Joundi, Gustavo Saposnik, Rosemary Martino, Jiming Fang, Moira K. Kapral Source Type: research
Effectiveness of an Interdisciplinary, Nurse Driven In-Hospital Code Stroke Protocol on In-Patient Ischemic Stroke Recognition and Management
Background: In-hospital strokes account for up to nearly 1 in 5 strokes. Clinical outcomes, such as length of stay, disability, and mortality are worse for in-hospital strokes than for those that occur in the community. For a variety of reasons, stroke can be more difficult to recognize and treat in hospitalized patients. Earlier recognition of stroke results in better clinical outcomes, presumably due to faster diagnosis and subsequently, prompt treatment. Methods: This investigation was a retrospective, interrupted time series, observational study of all in-hospital stroke patients between 2008 and 2017.
Source: Journal of Stroke and Cerebrovascular Diseases - October 1, 2019 Category: Neurology Authors: Sarah Jane Yang, Th érèse Franco, Nicolai Wallace, Barbara Williams, Craig Blackmore Source Type: research
Prehospital and Emergency Department-Focused Mission Protocol Improves Thrombolysis Metrics for Suspected Acute Stroke Patients
Background: The Mission Protocol was implemented in 2017 to expedite stroke evaluation and reduce door-to-needle (DTN) times at Zuckerberg San Francisco General Hospital. The key system changes were team-based evaluation of suspected stroke patients at ambulance entrance by an Emergency Department (ED) physician, ED nurse, and neurologist and immediate emergency medical service (EMS) provider transport of patients to CT. Methods: Patients were eligible for a Mission Protocol prehospital stroke activation if an EMS provider found a positive Cincinnati Prehospital Stroke Scale and a last known normal time within 6 hours.
Source: Journal of Stroke and Cerebrovascular Diseases - October 8, 2019 Category: Neurology Authors: Debbie Y. Madhok, Kevin J. Keenan, Sara B. Cole, Christine Martin, J. Claude Hemphill Source Type: research
Race-Ethnic Disparities in 30-Day Readmission After Stroke Among Medicare Beneficiaries in the Florida Stroke Registry
Objective: To examine racial/ethnic disparities in 30-day all-cause readmission after stroke. Methods: Thirty-day all-cause readmission was compared by race/ethnicity among Medicare fee-for-service beneficiaries discharged for ischemic stroke from hospitals in the Florida Stroke Registry from 2010 to 2013. We fit a Cox proportional hazards model that censored for death and adjusted for age, sex, length of stay, discharge home, and comorbidities to assess racial/ethnic differences in readmission.
Source: Journal of Stroke and Cerebrovascular Diseases - October 10, 2019 Category: Neurology Authors: Hannah Gardener, Erica C. Leifheit, Judith H. Lichtman, Kefeng Wang, Yun Wang, Carolina M. Gutierrez, Maria A. Ciliberti-Vargas, Chuanhui Dong, Mary Robichaux, Jose G. Romano, Ralph L. Sacco, Tatjana Rundek, FL-PR CReSD Investigators and Collaborators Source Type: research
Quality improvement project leads to better care of all stroke patients: Together we are stronger
Since the publication of the first IV thrombolysis trial with alteplase1 and subsequent analyses showing a strong correlation between early treatment and favorable outcome,2,3 the medical community has been focused on early identification of stroke and rapid delivery of suspected patients to the nearest alteplase-capable hospital. The importance of early stroke treatment created a need for a stroke system of care where there is a widespread network of medical facilities in which IV alteplase can be administered, and subsequent care can take place at another facility of higher level of care. The state of Minnesota has adopt...
Source: Neurology Clinical Practice - October 13, 2019 Category: Neurology Authors: Hussein, H. M., Ng, F. C. Tags: All Cerebrovascular disease/Stroke Editorial Source Type: research
Extreme Gradient Boosting Model Has a Better Performance in Predicting the Risk of 90-Day Readmissions in Patients with Ischaemic Stroke
Ischemic stroke readmission within 90 days of hospital discharge is an important quality of care metric. The readmission rates of ischemic stroke patients are usually higher than those of patients with other chronic diseases. Our aim was to identify the ischemic stroke readmission risk factors and establish a 90-day readmission prediction model for first-time ischemic stroke patients.
Source: Journal of Stroke and Cerebrovascular Diseases - October 14, 2019 Category: Neurology Authors: Yuan Xu, Xinlei Yang, Hui Huang, Chen Peng, Yanqiu Ge, Honghu Wu, Jiajing Wang, Gang Xiong, Yingping Yi Source Type: research
Analysis of Clinical Symptoms and Brain MRI of Heat Stroke: 2 Case Reports and a Literature Review
Introduction: Heat stroke is defined as high body temperature causing multiple organ failure, psychological change, seizure, and consciousness disturbance, which lead to its high mortality rate. However, the involvement of brain injury is rare, and heat-stroke has only been reported in a few case reports or case series. The purpose of this case study was to evaluate the clinical symptoms and radiological features of heat stroke. Methods: We reviewed our hospital records and previously published reports to find cases of heat stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - November 25, 2019 Category: Neurology Authors: Tomoyo Shimada, Nobukazu Miyamoto, Yoshiaki Shimada, Masao Watanabe, Hideki Shimura, Yuji Ueno, Kazuo Yamashiro, Nobutaka Hattori, Takao Urabe Source Type: research
Influence of a Comorbid Diagnosis of Seizure on 30-Day Readmission Rates Following Hospitalization for an Index Stroke
Objective: To examine the association of a comorbid seizure diagnosis with early hospital readmission rates following an index hospitalization for stroke in the United States. Methods: Retrospective analysis of the 2014 National Readmission Database. The study population included adult patients (age>18 years old) with stroke, identified using the International Classification of Disease Ninth Revision, Clinical Modification (ICD-9-CM) codes 433.X1, 434.X1, and 436 for ischemic stroke as well as 430, 431, 432.0, 432.1, and 432.9 for hemorrhagic stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - November 25, 2019 Category: Neurology Authors: Alain Lekoubou, Kinfe G Bishu, Bruce Ovbiagele Source Type: research
Field Assessment of Critical Stroke by Emergency Services for Acute Delivery to a Comprehensive Stroke Center: FACE 2 AD
AbstractPatients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) should be triaged to an endovascular-capable hospital by the emergency medical service (EMS). We designed a prehospital LVO prediction scale based on EMS assessments. In the derivation cohort, 1157 patients transferred to our hospital by the EMS because of suspected stroke within 24 h of onset were retrospectively examined. Factors associated with AIS due to LVO were identified based on the EMS assessment, and a prehospital scale identifying LVO was developed. The accuracy of this scale was validated in 502 consecutive patients who were t...
Source: Translational Stroke Research - December 11, 2019 Category: Neurology Source Type: research
Risk Factors and Outcomes of Cerebral Stroke in End-Stage Renal Disease Patients Receiving Hemodialysis
This study investigated the stroke features and risk factors in hemodialysis (HD) patients. Methods: All end-stage renal disease patients undergoing HD at Teraoka Memorial Hospital dialysis center were identified, with 195 recruited. Baseline clinical characteristics were collected, and the clinical outcomes and related factors of stroke in HD patients were retrospectively analyzed.
Source: Journal of Stroke and Cerebrovascular Diseases - February 5, 2020 Category: Neurology Authors: Yuki Shinya, Satoru Miyawaki, Isao Kumagai, Takehiro Sugiyama, Atsumi Takenobu, Nobuhito Saito, Akira Teraoka Source Type: research
Incidence of Hospitalization for Stroke in Queensland, Australia: Younger Adults at Risk
Background: Trends in the incidence of stroke are important for health care planning. Information is particularly scarce in Australia, due to the paucity of studies with access to recent, large-scale, longitudinal datasets. In this paper we investigated the incidence of hospitalization for stroke by sex, age, and subtype in the whole State of Queensland (Australia). Methods: We obtained data of all hospital admissions for stroke in Queensland from 2002 to 2015. Age standardized hospitalization rates for first-ever stroke were calculated along with WHO adjusted rates.
Source: Journal of Stroke and Cerebrovascular Diseases - April 8, 2020 Category: Neurology Authors: Deanna Anderlini, Guy Wallis, Welber Marinovic Source Type: research
Association between obstructive sleep apnea and risk of post-stroke depression: A hospital-based study in ischemic stroke patients
This study aimed to detect the correlation between OSA severity and post-stroke depression (PSD) in ischemic stroke patients.
Source: Journal of Stroke and Cerebrovascular Diseases - May 13, 2020 Category: Neurology Authors: Chuanyou Li, Yuanyue Liu, Pengfei Xu, Qiqi Fan, Pengyu Gong, Caixia Ding, Lei Sheng, Xiaohao Zhang Source Type: research
Left Atrial Dilation and Risk of One-Year Readmission after Embolic Stroke of Undetermined Source
: Structural left atrial and ventricular abnormalities on the electrocardiogram (ECG) and transthoracic echocardiogram (TTE) at the time of ischemic stroke have been associated with morbidity and mortality. Yet, the prognostic impact of the same in embolic stroke of undetermined source (ESUS), a relevant subtype of ischemic stroke with a unique pathophysiology, has not been well studied to date. Our aim was to assess the predictive impact of left atrio-ventricular ECG and TTE abnormalities on one-year hospital readmission after ESUS from an ongoing single center prospective stroke registry in the U.S.
Source: Journal of Stroke and Cerebrovascular Diseases - July 15, 2020 Category: Neurology Authors: Vikrant Jagadeesan, Austin Culver, Nisha Raiker, Quinn Halverson, Sameer Prasada, Liqi Chen, Leah J. Welty, Shyam Prabhakaran, Kameswari Maganti Source Type: research
