Deaths from cerebrovascular diseases correlated to month of birth: elevated risk of death from subarachnoid hemorrhage among summer-born

Object The goal of this study was to determine racial/ethnic differences in inpatient mortality rates and the use of institutional postacute care following subarachnoid hemorrhage (SAH) in the US. Methods A cross-sectional study of hospital discharges for SAH was conducted using the Nationwide Inpatient Sample for the years 2005–2010. Discharges with a principal diagnosis of SAH were identified and abstracted using the appropriate ICD-9-CM diagnostic code. Racial/ethnic groups were defined as white, black, Hispanic, Asian/Pacific Islander (API), and American Indian. Multinomial logistic regression analyses were performed comparing racial/ethnic groups with respect to the primary outcome of risk of in-hospital mortality and the secondary outcome of likelihood of discharge to institutional care. Results During the study period, 31,631 discharges were related to SAH. Race/ethnicity was a significant predictor of death (p = 0.003) and discharge to institutional care (p ≤ 0.001). In the adjusted analysis, compared with white patients, API patients were at higher risk of death (OR 1.34, 95% CI 1.13–1.59) and Hispanic patients were at lower risk of death (OR 0.84, 95% CI 0.72–0.97). The likelihood of discharge to institutional care was statistically similar between white, Hispanic, API, and Native American patients. Black patients were more likely to be discharged to institutional care compared with white patients (OR 1.27, 95% CI 1.14–1.40), but were similar to white patients in the risk of death. Conclusions Significant racial/ethnic differences are present in the risk of inpatient mortality and discharge to institutional care among patients with SAH in the US. Outcome is likely to be poor among API patients and best among Hispanic patients compared with other groups.

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Very low level of microalbuminuria is associated with increased risk of death in subjects with cardiovascular or cerebrovascular diseases

Journal of Internal Medicine ◽

10.1111/j.1365-2796.2006.01679.x ◽

2006 ◽

Vol 260 (3) ◽

pp. 231-237 ◽

Cited By ~ 50

Author(s):

K. P. KLAUSEN ◽

H. SCHARLING ◽

J. S. JENSEN

Keyword(s):

Cerebrovascular Diseases ◽

Low Level ◽

Risk Of Death ◽

Increased Risk

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Risk Factors for Myocardial Infarction and Stroke Among Sepsis Survivors: A Competing Risks Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066619844936 ◽

2019 ◽

Vol 35 (1) ◽

pp. 34-41

Author(s):

Yueh-Che Hsieh ◽

Po-Yang Tsou ◽

Yu-Hsun Wang ◽

Christin Chih-Ting Chao ◽

Wan-Chien Lee ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Hospital Discharge ◽

Preventive Measures ◽

Risk Model ◽

Cerebrovascular Diseases ◽

Competing Risk ◽

Research Database ◽

Risk Of Death ◽

Increased Risk

Objectives: Predictors for post-sepsis myocardial infarction (MI) and stroke are yet to be identified due to the competing risk of death. Methods: This study included all hospitalized patients with sepsis from National Health Insurance Research Database of Taiwan between 2000 and 2011. The primary outcome was the first occurrence of MI and stroke requiring hospitalization within 180 days following hospital discharge from the index sepsis episode. The association between predictors and post-sepsis MI and stroke were analyzed using cumulative incidence competing risk model that controlled for the competing risk of death. Results: Among 42 316 patients with sepsis, 1012 (2.4%) patients developed MI and stroke within 180 days of hospital discharge. The leading 5 predictors for post-sepsis MI and stroke are prior cerebrovascular diseases (hazard ratio [HR]: 2.02, 95% confidence interval [CI]: 1.74-2.32), intra-abdominal infection (HR: 1.94, 95% CI: 1.71-2.20), previous MI (HR: 1.81, 95% CI: 1.53-2.15), lower respiratory tract infection (HR: 1.62, 95% CI: 1.43-1.85), and septic encephalopathy (HR: 1.61, 95% CI: 1.26-2.06). Conclusions: Baseline comorbidities and sources of infection were associated with an increased risk of post-sepsis MI and stroke. The identified risk factors may help physicians select a group of patients with sepsis who may benefit from preventive measures, antiplatelet treatment, and other preventive measures for post-sepsis MI and stroke.

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mHOMR: a feasibility study of an automated system for identifying inpatients having an elevated risk of 1-year mortality

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-009285 ◽

2019 ◽

pp. bmjqs-2018-009285 ◽

Cited By ~ 2

Author(s):

Pete Wegier ◽

Ellen Koo ◽

Shahin Ansari ◽

Daniel Kobewka ◽

Erin O'Connor ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Feasibility Study ◽

Mortality Risk ◽

End Of Life Care ◽

Elevated Risk ◽

Life Care ◽

Risk Of Death ◽

Palliative Care Consultation ◽

Care Consultation

ObjectiveThe need for clinical staff to reliably identify patients with a shortened life expectancy is an obstacle to improving palliative and end-of-life care. We developed and evaluated the feasibility of an automated tool to identify patients with a high risk of death in the next year to prompt treating physicians to consider a palliative approach and reduce the identification burden faced by clinical staff.MethodsTwo-phase feasibility study conducted at two quaternary healthcare facilities in Toronto, Canada. We modified the Hospitalised-patient One-year Mortality Risk (HOMR) score, which identifies patients having an elevated 1-year mortality risk, to use only data available at the time of admission. An application prompted the admitting team when patients had an elevated mortality risk and suggested a palliative approach. The incidences of goals of care discussions and/or palliative care consultation were abstracted from medical records.ResultsOur model (C-statistic=0.89) was found to be similarly accurate to the original HOMR score and identified 15.8% and 12.2% of admitted patients at Sites 1 and 2, respectively. Of 400 patients included, the most common indications for admission included a frailty condition (219, 55%), chronic organ failure (91, 23%) and cancer (78, 20%). At Site 1 (integrated notification), patients with the notification were significantly more likely to have a discussion about goals of care and/or palliative care consultation (35% vs 20%, p = 0.016). At Site 2 (electronic mail), there was no significant difference (45% vs 53%, p = 0.322).ConclusionsOur application is an accurate, feasible and timely identification tool for patients at elevated risk of death in the next year and may be effective for improving palliative and end-of-life care.

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Prognosis of Patients Victim of Spontaneous Subarachnoid Hemorrhage: A Comparison between Radiologic Scales

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0039-3399537 ◽

2020 ◽

Vol 39 (01) ◽

pp. 001-004

Author(s):

Luiza Maria Dias Abboud Hanna ◽

Sarah Eloisa Biguelini ◽

Francisco Alves de Araujo Junior ◽

Anderson Matsubara ◽

Pedro Helo dos Santos Neto

Keyword(s):

Subarachnoid Hemorrhage ◽

Medical Records ◽

Early Mortality ◽

Clinical Scale ◽

Risk Of Death ◽

Risk Of Mortality ◽

Life Habits ◽

Spontaneous Subarachnoid Hemorrhage ◽

The City ◽

Better Than

Abstract Objective To analyze the population and the early mortality rate (up to thirty days) of patients victim of spontaneous subarachnoid hemorrhage (SAH) according to the Hunt-Hess clinical scale and the Fisher and modified Fisher radiological scales. Materials and Methods We analyzed 46 medical records and skull computed tomography (CT) scans of patients with spontaneous SAH admitted between February 2014 and December 2017 at Hospital Universitário Evangélico Mackenzie, in the city of Curitiba, state of Paraná, Brazil. The method of the study was exploratory-descriptive, transversal and retrospective, with a quantitative approach. We analyzed epidemiological (gender, age), clinical (life habits, pathologies, Glasgow coma scale and Hunt-Hess scale) and radiological (Fisher and modified Fisher scales) variables, and the Hunt-Hess and the Fisher scales were correlated with risk of death. The data was submitted to statistical analysis considering values of p < 0.05. Result There was a higher prevalence of spontaneous SAH among women (69.5%), as well as among patients aged between 51 and 60 years (34.7%). Regarding the grades on the scales, there was higher prevalence of Fisher 4, Modified Fisher 4 and Hunt-Hess 2. Evolution to death was higher among women (76.4%) and patients aged between 61 and 70 years (35,2%). Conclusion Mortality was higher among patients classified as Fisher 3, Modified Fisher 4 and Hunt-Hess ≥ 3. The Fisher scale is better than the modified Fisher scale to assess the risk of mortality.

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Systematic review of the prevention of delayed ischemic neurological deficits with hypertension, hypervolemia, and hemodilution therapy following subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.2003.98.5.0978 ◽

2003 ◽

Vol 98 (5) ◽

pp. 978-984 ◽

Cited By ~ 149

Author(s):

Miriam M. Treggiari ◽

Bernhard Walder ◽

Peter M. Suter ◽

Jacques-André Romand

Keyword(s):

Systematic Review ◽

Subarachnoid Hemorrhage ◽

Relative Risk ◽

Sensitivity Analyses ◽

Neurological Deficits ◽

Content Type ◽

Risk Of Death ◽

Symptomatic Vasospasm ◽

Triple H ◽

Fine Print

Object. There is uncertainty about the efficacy of hypertension, hypervolemia, and hemodilution (triple-H) therapy in reducing the occurrence of delayed ischemic neurological deficits (DINDs) and death after subarachnoid hemorrhage. The authors therefore conducted a systematic review to evaluate the efficacy of triple-H prevention in decreasing the rate of clinical vasospasm, DINDs, and death. Methods. The authors systematically reviewed studies identified based on a MEDLINE, EMBASE, and COCHRANE Register search of articles published between 1966 and 2001, and reference lists of identified articles. An independent assessment of each study's methodological quality, population, intervention, and outcomes (rates of symptomatic vasospasm, DINDs, and death) was performed. Summary relative risk estimates were calculated for the main outcomes using fixed- or random-effect models, as appropriate. Only four prospective, comparative studies with a total of 488 patients were identified. The median internal validity score was 0.5 (range 0–2); the median external validity score was 3 (range 2–6). Compared with no prevention, triple-H therapy was associated with a reduced risk of symptomatic vasospasm (relative risk [RR] 0.45, 95% confidence interval [CI] 0.32–0.65), but not DIND (RR 0.54, 95% CI 0.2–1.49). The risk of death was higher (RR 0.68, 95% CI 0.53–0.87). Sensitivity analyses including only randomized, controlled trials showed no evidence of statistically significant results for these major end points. Conclusions. The paucity of information and important limitations in the design of the studies analyzed preclude evaluation of the efficacy of triple-H prevention and formulation of any recommendations regarding its use for the prevention of cerebral vasospasm.

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