Follow up after burn injury is disturbingly low and linked with social factors

2021 ◽  
Author(s):  
Irina P Karashchuk ◽  
Eve A Solomon ◽  
David G Greenhalgh ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
...  
Keyword(s):  
Social History ◽  
Drug Dependence ◽  
Burn Injury ◽  
Retrospective Chart Review ◽  
Burn Patients ◽  
Chi Square ◽  
Factors Associated ◽  
Ed Visits ◽  
Zip Code

Abstract For medical and social reasons, it is important that burn patients attend follow up appointments (FUAs). Our goal was to examine the factors leading to missed FUAs in burn patients. A retrospective chart review was conducted of adult patients admitted to the burn center from 2016-2018. Data collected included burn characteristics, social history, and zip code. Data analysis was conducted using chi-square, Wilcox Rank Sum tests, and multivariate regression models. A total of 878 patients were analyzed, with 224 (25.5%) failing to attend any FUAs and 492 (56.0%) missing at least one appointment (MA). Patients who did not attend any FUAs had smaller burns (4.5 (8)% vs. 6.5 (11)% median (inter quartile range)), traveled farther (70.2 (111.8) vs. 52.5 (76.7) miles), and were more likely to be homeless (22.8% vs. 6.9%) and have drug dependence (47.3% vs. 27.2%). Patients who had at least one MA were younger (42 (26) vs. 46 (28) years) and more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never attending a FUA were: distance from hospital (odds ratio (OR) 1.004), burn size (OR 0.96), and homelessness (OR 0.33). Factors associated with missing at least one FUA : age (OR 0.99), drug dependence (OR 0.46), homelessness (OR 0.22), and ED visits (OR 0.56). A high percentage of patients fail to make any appointment following their injury and/or have at least one MA. Both FUAs and MAs are influenced by social determinants of health.

2 Rates of Follow up After Burn Injury Are Disturbingly Low and Linked with Social Factors

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S7-S7
Author(s):  
Irina P Karashchuk ◽  
Eve A Solomon ◽  
David G Greenhalgh ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
...  
Keyword(s):  
Low Socioeconomic Status ◽  
Drug Dependence ◽  
Burn Injury ◽  
Retrospective Chart Review ◽  
Missed Appointments ◽  
Poverty Level ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Burn Center

Abstract Introduction Due to risks of scarring and difficulties with re-socialization, it is important that burn patients attend follow up appointments to minimize adverse sequelae. Studies in trauma and emergency medicine have shown a correlation between reduced follow up and low socioeconomic status. Our goal was to examine the factors leading to missed follow up appointments in the burn center population. Methods Following IRB approval, a retrospective chart review was conducted using electronic medical records of all adult patients admitted to the burn center from 2016–2018. Data collected included information on burn injury, social status, substance use, and zip code demographics. Exclusions included patients with non-burn injuries, who died in the hospital, who were transferred to another hospital, who did not have any scheduled outpatient follow up, who had insurance which precluded follow up at our institution, and prisoners. Data analysis was conducted using chi-square, t-test, linear, and logistic regression models. Results A total of 878 patients (mean age 45.1 ± 16.8 years, 646 males (73.6%), mean burn size (TBSA) 10.16±11.7%) were analyzed. In our population, 96 (10.93%) patients were homeless, 284 (32.35%) had drug dependence, 128 (14.58%) had alcoholism, and the mean poverty level was 17.7±8.34%. Of those analyzed, 224 (25.5%) failed to attend any follow up appointments and 492 (56.0%) had at least one missed appointment. Patients who did not attend any follow up appointments had smaller burns (8.2±9.5% vs. 10.8±12.3%), traveled farther (91.8±101.1 miles vs. 69.0±68.7 miles), were more likely to be homeless (22.8% vs. 6.9%) and to have drug dependence (47.3% vs. 27.2%). Patients who missed at least one appointment were younger (43.8±16.1vs. 46.8±17.4 years), more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never returning to clinic were: Distance from hospital (odds ratio (OR) 1.004, p=0.0001), TBSA (OR 0.96, p= 0.0001), Drug Dependence (OR 0.49, p< 0.0001), and Homelessness (OR 0.31, p< 0.0001). Factors associated with missing at least one appointment were: Age (OR 0.99 p< 0.03), Drug Dependence (OR 0.51, p< 0.0001), Homelessness (OR 0.20, p< 0.0001), and ED visits (OR 0.57, p< 0.05). Conclusions In our population, a high percentage of patients fail to make any appointment following their injury and an even higher number miss at least one appointment. The factors that influence failure to return and missing at least one appointment are similar but not exactly the same. Both follow up and missed appointments are influenced by social determinants of health.

53 Frailty is Not Only a Phenomenon of Elderly Burn Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S38-S39
Author(s):  
Kathleen S Romanowski ◽  
Melissa J Grigsby ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
David G Greenhalgh
Keyword(s):  
Chart Review ◽  
Burn Injury ◽  
Frailty Index ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Burn Patients ◽  
Chi Square ◽  
Frail Patients ◽  
Modified Frailty Index

Abstract Introduction Recent evidence indicates that increased frailty is associated with increased mortality in patients with burn injuries over the age of 50 years old. This work found that 35.7% of burn patients over 65 years old were frail at the time of their burn admission while 19.2% of burn patients 50 to 64 years old were frail. While frailty is associated with increased age the two are separate entities suggesting that frailty may be present in much younger patients who present with burn injuries. We hypothesize that frailty exists in all age groups of patients presenting with burn injury and the prevalence increases with age. Methods Following IRB approval, a 5-year (2014–2019) retrospective chart review was conducted of all burn patients admitted to the burn center. Data collected includes age, gender, and burn size (% TBSA). Frailty was determined using the Modified Frailty Index 11 (MFI 11) from co-morbidities included in the burn registry. Patients were considered frail if they have an MFI ³ 2 and pre-frail for an MFI³1 and < 2. Patients were assessed by decades for age. Statistical analysis included descriptive statistics, chi-square, and t-tests. Results A total of 2173 patients (mean age 46.1±17.3 years, 1584 males (72.8%), mean % TBSA 12.5±16.3%) were analyzed. All age groups included patients who were pre-frail (Table 1). In the under 20-year-old group, 8.5% were pre-frail. This increases with each age group to the 71-80-year-old group in which 41.7% of patients are pre-frail. The over 80-year-old group had slightly fewer pre-frail patients (35.9%). There were no frail patients in the under 20-year-old group. In the 21–30 there were 3 patients (0.7%) that had an MFI of 2 or more placing them in the frail group. Frailty was significantly different across the age groups (p< 0.001). As patients age, the proportion of female patients increases (from 17.6% to 37.5%. p< 0.0001). Frailty was also associated with gender with women having a higher percentage of frailty (p=0.0006). With respect to burn size, age category was not associated with burn size (p=0.12), but frail patients had smaller burns than non-frail or pre-frail patients (9.5% vs. 13.3% vs. 12.2%, p=0.0002). Conclusions Pre-frail patients were identified in all age groups. Frailty was present in all age groups except for those who are under 20 years of age. Frailty was associated with female sex and smaller burns. By not specifically looking for frailty in all burn patients admitted to the hospital we are potentially missing frail patients who may benefit from interventions to improve their outcomes.

New Perspectives on Risk Factors for Non-fatal Strangulation and Post-assault Imaging

2020 ◽  
pp. 088626052096667
Author(s):  
Grace B. McKee ◽  
Kathy Gill-Hopple ◽  
Daniel W. Oesterle ◽  
Leah E. Daigle ◽  
Amanda K. Gilmore
Keyword(s):  
Sexual Assault ◽  
Partner Violence ◽  
Intimate Partner ◽  
Chi Square ◽  
Factors Associated ◽  
Bodily Injury ◽  
Weapon Use ◽  
Chi Square Analysis ◽  
Assault Characteristics

Strangulation has long been associated with death in the context of sexual assault and intimate partner violence (IPV). Non-fatal strangulation (NFS) during sexual assault, which refers to strangulation or choking that does not result in death, is common and has been associated with IPV and with bodily injury; however, other factors associated with NFS are unknown. The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam (SAMFE). A second purpose of this study was to explore factors associated with receiving follow-up imaging orders after NFS was identified during a SAMFE. Participants ( N = 882) ranged in age from 18 to 81 ( M = 28.85), with the majority identifying as non-Hispanic White (70.4%) or Black/African American (23.4%). A total of 75 women (8.5%) experienced NFS during the sexual assault. Of these, only 13 (17.3%) received follow-up imaging orders for relevant scans. Results from a logistic regression analysis demonstrated that NFS was positively associated with report of anal penetration, intimate partner perpetration, non-genital injury, and weapon use during the assault. Results from chi-square analysis showed that among sexual assaults involving women who experienced NFS, those whose assaults involved weapon use were over four times more likely to receive imaging orders compared to assaults without weapon use. These findings have implications for criminal justice, and if incorporated into danger assessments, could potentially reduce fatalities linked to sexual assault and/or IPV. Additional work is needed to ensure that all assaults with NFS trigger a referral for imaging regardless of other assault characteristics.

826 Geographic Mapping to Target Adult Burn Prevention for an Urban Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S252-S252
Author(s):  
Mathangi A Chandramouli ◽  
Angela Rabbitts ◽  
Jamie Heffernan ◽  
Philip Chang
Keyword(s):  
Catchment Area ◽  
Burn Injury ◽  
Adult Population ◽  
Data Mapping ◽  
Burn Patients ◽  
Unequal Distribution ◽  
Burn Center ◽  
Burn Prevention ◽  
National Trends ◽  
Zip Code

Abstract Introduction Burn prevention is one of the core missions of burn centers. Geomapping has been instrumental for police departments to target resources for crime prevention. Similarly, geomapping could assist burn specialists in identifying “hotspots” of injury. The purpose of this study is to visually identify the incidence and location of adult burn injury within the catchment area of a single tertiary urban regional burn center. Data mapping can thus then be used to target burn outreach and prevention efforts. Methods Demographic and deidentified clinical data was collected from a single institution over a 3 year period. 1986 burn patients were admitted between 1/2016 and 12/2018. 1360 patients were 16 years of age or greater. Geriatric patients were defined as age 60 or greater to facilitate comparison with National Burn Repository data which breaks down age by decades. The patients were mapped by their home zip code. Results 1360 burn patients 16 years or older were admitted to this single tertiary burn center between 1/2016 and 12/2018 with an age range from 16–101. 393 patients were 60 years or older (28.9% of the adult population compared to 19.8% of the NBR population) 6 zip codes within the catchment area were identified as “hotspots” as having more than 30 inpatients listing that zip code as their home address (see figure). The results show an unequal distribution of patients over the burn center’s catchment area with hotspots (defined by > 30 burn admissions during the study period) in 6 zip codes. Conclusions The local demographics of this inpatient adult burn population follow national trends in etiology but differ with regards to age and race. The geomapping tool visualizes burn incidence by geography. Based on this analysis, outreach and prevention efforts should target elderly populations especially in the “hotspots.” Applicability of Research to Practice This research will inform targeted efforts towards burn prevention and education outreach.

596 ICU Sedation Practices for Mechanically Ventilated Burn Patients Following Guideline Implementation

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
Jeffrey H Anderson ◽  
Samuel P Mandell
Keyword(s):  
Management Practices ◽  
Burn Injury ◽  
Guideline Implementation ◽  
Single Agent ◽  
Retrospective Chart Review ◽  
Opioid Analgesics ◽  
Burn Patients ◽  
Background Pain ◽  
The Difference ◽  
Icu Sedation

Abstract Introduction Our American Burn Association verified regional burn center has approximately 700 admissions for burn injury per year, 200 of which are admitted to the burn intensive care unit (BICU). Sedation practices during acute burn resuscitations remain variable. In order to standardize our sedation practices, we developed a Background Pain and Anxiety Decision Tree for Mechanically Intubated Adults in March 2017. Concern over hypotension led to the removal of propofol as the sedative of choice. The new protocol made midazolam the primary choice and recommended the use of adjunct analgesics, including acetaminophen, for background pain. It uses the Richmond Agitation Sedation Scale (RASS) to determine whether patients were oversedated (RASS< 0) or anxious (RASS >1+). Methods We conducted a single center retrospective chart review on intubated patients admitted to the BICU from November 2017 through November 2018. Data collection focused primarily on sedation practices during this time to determine whether our protocol had the desired effects. Highest and lowest RASS were collected, and the difference between the two (delta RASS) was used to determine changes in patient agitation and sedation. Results Thirty three adult patients requiring mechanical ventilation were admitted to the BICU between November 2017 and November 2018. Of these patients, 21 (66%) received propofol on hospital day one, and 12 (38%) received propofol on hospital day two. Eleven patients received both propofol and midazolam on hospital day one. Of these patients, the average propofol dose was 511 micrograms per day and the average midazolam dose was 13.3mg per day (p=0.02). Eighteen (56%) and twenty five (78%) patients received acetaminophen on hospital days one and two, respectively. Twenty four patients had a RASS recorded during their first hospital day. The average highest RASS recorded was 1.3 and the average lowest recorded RASS was -3.2. Patients who received both propofol and midazolam had a higher peak RASS (2.4) and a lower minimum RASS (3.4), creating a larger delta RASS for this group. Conclusions Despite eliminating propofol from our sedation guidelines, its use remains the predominant mode of sedation for burn patients throughout the first forty eight hours of hospitalization. There is also room for improvement for administration of non-opioid analgesics, including acetaminophen. Finally, our ventilated patients tend to be more oversedated than undersedated, and a combination of midazolam and propofol creates the largest swings in patients’ sedation and agitation status. Applicability of Research to Practice Changing sedation and pain management practices in the ICU is a multifactorial process that requires more than ICU guideline implementation. The use of two sedatives during the first hospital day can result in larger swings in RASS as opposed to use of a single agent.

Factors Associated With Pediatric Burn Clinic Follow-up After Emergency Department Discharge

2021 ◽  
Author(s):  
Paige L Seegan ◽  
Kavya Tangella ◽  
Nicholas P Seivert ◽  
Elizabeth Reynolds ◽  
Andrea S Young ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sociodemographic Factors ◽  
Burn Patients ◽  
Targeted Interventions ◽  
Factors Associated ◽  
Patient Gender ◽  
Race Ethnicity ◽  
Emergency Department Discharge ◽  
Improve Health

Abstract Attrition between emergency department discharge and outpatient follow-up is well documented across a variety of pediatric ailments. Given the importance of outpatient medical care and the lack of related research in pediatric burn populations, we examined sociodemographic factors and burn characteristics associated with outpatient follow-up adherence among pediatric burn patients. A retrospective review of medical records was conducted on patient data extracted from a burn registry database at an urban academic children’s hospital over a 2-year period (January 2018–December 2019). All patients were treated in the emergency department and discharged with instructions to follow-up in an outpatient burn clinic within 1 week. A total of 196 patients (Mage = 5.5 years; 54% male) were included in analyses. Average % TBSA was 1.9 (SD = 1.5%). One third of pediatric burn patients (33%) did not attend outpatient follow-up as instructed. Older patients (odds ratio [OR] = 1.00; 95% confidence interval [CI]: [0.99–1.00], P = .045), patients with superficial burns (OR = 9.37; 95% CI: [2.50–35.16], P = .001), patients with smaller % TBSA (OR = 1.37; 95% CI: [1.07–1.76], P = .014), and patients with Medicaid insurance (OR = 0.22; 95% CI: [0.09–0.57], P = .002) or uninsured/unknown insurance (OR = 0.07; 95% CI: [0.02–0.26], P = .000) were less likely to follow up, respectively. Patient gender, race, ethnicity, and distance to clinic were not associated with follow-up. Follow-up attrition in our sample suggests a need for additional research identifying factors associated with adherence to follow-up care. Identifying factors associated with follow-up adherence is an essential step in developing targeted interventions to improve health outcomes in this at-risk population.

Factors associated with a negative outcome of medication-overuse headache: A 3-year follow-up (the ‘CARE’ protocol)

Cephalalgia ◽  
2013 ◽  
Vol 33 (7) ◽  
pp. 431-443 ◽  
Author(s):  
Grazia Sances ◽  
Federica Galli ◽  
Natascia Ghiotto ◽  
Marta Allena ◽  
Elena Guaschino ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Minnesota Multiphasic Personality Inventory ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Chi Square ◽  
Factors Associated ◽  
Care Protocol ◽  
Socio Economic Variables ◽  
Negative Outcome

Aim To evaluate factors associated with a negative outcome in a 3-year follow-up of subjects diagnosed with medication-overuse headache (MOH) (revised-ICHD-II criteria). Methods All consecutive patients entering the center’s inpatient detoxification program were analyzed in a prospective, non-randomized fashion. All participants were assessed by a neurologist using an ad hoc patient record form. Personality was assessed using the Minnesota Multiphasic Personality Inventory (MMPI)-2, Chi-square test, one-way analysis of variance (ANOVA), and odds ratios (OR) were calculated as appropriate. Results One-hundred and fifty patients completed the follow-up (79.3% females, age 46.40 ± 11.31 years): 13 never stopped their drug overuse (A), 38 stopped their overuse, but relapsed at least once (B), and 99 stopped and never relapsed (C). The Group A patients differed from those in B + C as they were more frequently single (OR 0.134; p = 0.007) and unemployed (OR 3.273; p = 0.04), took a higher number of drug doses ( p < 0.001), and less frequently drank coffee (OR 3.273; p = 0.044). Personality profile: subjects in A scored higher than those in C on the following scales: Hypochondriasis ( p = 0.007), Depression ( p = 0.003), Paranoia ( p = 0.025), Fears ( p = 0.003), Obsessiveness ( p = 0.026), Bizarre Mentation ( p = 0.046), Social Discomfort ( p = 0.004), Negative Treatment Indicators ( p = 0.040), Repression ( p = 0.007), Overcontrolled Hostility ( p = 0.040), Addiction Admission ( p = 0.021), Social Responsibility ( p = 0.039), and Marital Distress ( p = 0.028). Conclusion Disease outcome in MOH patients is influenced negatively by overuse severity and by specific psychological and socio-economic variables. Other possible modifier factors were voluptuary habits.

scholarly journals Burns in a Suburban Teaching Hospital: A Retrospective Record Review in Kanchipuram, India

2021 ◽  
pp. 423-429
Author(s):  
Sai Aishwarya Thakku Yoganathan ◽  
Alagar Raja Durairaj ◽  
Surya Rao Rao Venkata Mahipathy ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran ◽  
...  
Keyword(s):  
Rural Areas ◽  
Burn Injury ◽  
Well Being ◽  
Economic Loss ◽  
Demographic Variables ◽  
Burn Injuries ◽  
High Morbidity ◽  
Burn Patients ◽  
Chi Square ◽  
Cultural Aspects

Background: Burn injuries rank among the most severe type of injury with high morbidity and mortality worldwide. Burn injuries not only affect patients physical health but also affects their social and psychological well being along with severe economic loss to the individual, their family and to the society. About 90% burn injuries are preventable, but poor adherence of safety measures and awareness leads to disability and disfigurement throughout their life. Hence, the need for various demographic variables to understand the cause and pattern in our region are required. Objectives: To describe the demographic and socio-cultural aspects of burn patients and to learn the cause of burn victims in our region. Materials and Methods: A record based retrospective study was conducted at Saveetha Medical College and Hospital, Thandalam, Kanchipuram district. The medical records of all patients over a period of 4 years (January 2017 to December 2020) were reviewed. Data were recorded on a pre-structured and pretested questionnaire. Chi-square test was done to study association between socio-demographic variables and burn injury and (p<0.05) was considered statistically significant. Results: A total of 208 burn cases were involved in this study out of which 56.7% were females and 43.3% were males. Most of the burn patients were 31-45 years and lived in rural areas. The majority of burn injuries were accidental; thermal burns was the most common cause of deep burns. Conclusion: Socio-demographic factors are important in raising educational programs and awareness in rural areas for improving quality of life.

scholarly journals Comparison of PRE and POST COVID-19 Pandemic burn statistics: Initial experience from Rawalian Burn Center, Holy Family Hospital, RMU, Rawalpindi, Pakistan

2021 ◽  
Vol 25 (1) ◽  
pp. 48-52
Author(s):  
Sajid Rashid
Keyword(s):  
Mortality Rate ◽  
Surface Area ◽  
Burn Injury ◽  
Control Period ◽  
Burn Patients ◽  
Chi Square ◽  
Cross Sectional ◽  
Burn Center ◽  
Chi Square Test ◽  
Surgery Department

Objectives: To determine the change in the trend of burn patient epidemiology after the COVID-19 pandemic in terms of frequency of burn injury and mortality rate.Material and Methods: This cross-sectional descriptive study was carried out at Rawalian burn center, Plastic Surgery Department, Holy Family Hospital RMU Rawalpindi from 1st March to 31st July over a period of 05 months. All burn patients reporting to the Rawalian burn center during the specified period were included in this study by consecutive sampling. Patients were mainly admitted from emergency and some from OPD following the standard admission, inclusion, and exclusion criteriaResults: Mean age of patients in the pre-COVID (Control) period March to July 2019 was 28.84 years with an SD of ±3.73. There were 63% females and 37% males. The total burn surface area range was 8-65% during this period. Whereas in the post-COVID period, March to July 2020 mean age of patients was 29.13 years with an SD of ±4.06. There were 60% females and 40% males. Whereas the total burn surface area range was 10-61% during this period. Frequency per month of burn injury progressively reduced to 58 patients and mortality rate to 1 in July 2020 (post-COVID period). The overall frequency of burn injury (n) during the control period was 367 patients whereas in the post-COVID period is reduced to 326 patients. So there was an 11.17% reduction as compared to the control period. A Chi-square test was applied and was found significant.Conclusion: Based on the current study it can be concluded that there is a progressive fall in frequency of burn injury and mortality rate during the ongoing COVID-19 pandemic as compared to the PRE-COVID period however further studies are needed to explore the cause of this falling trend.  

Predictive Clinical and Surgical Factors Associated with Recurrent Apoplexy in Pituitary Adenomas

2021 ◽  
Author(s):  
Alan Siu ◽  
Sanjeet Rangarajan ◽  
Michael Karsy ◽  
Christopher J. Farrell ◽  
Gurston Nyquist ◽  
...  
Keyword(s):  
Pituitary Apoplexy ◽  
Radiation Treatment ◽  
Univariate Analysis ◽  
Rare Event ◽  
Retrospective Chart Review ◽  
Subtotal Resection ◽  
Cavernous Sinus Invasion ◽  
Factors Associated ◽  
Increased Risk

Abstract Introduction Pituitary apoplexy is an uncommon clinical condition that can require urgent surgical intervention, but the factors resulting in recurrent apoplexy remain unclear. The purpose of this study is to determine the risks of a recurrent apoplexy and better understand the goals of surgical treatment. Methods A retrospective chart review was performed for all consecutive patients diagnosed and surgically treated for pituitary apoplexy from 2004 to 2021. Univariate analysis was performed to identify risk factors associated with recurrent apoplexy. Results A total of 115 patients were diagnosed with pituitary apoplexy with 11 patients showing recurrent apoplexy. This occurred at a rate of 2.2 cases per 100 patient-years of follow-up. There were no major differences in demographic factors, such as hypertension or anticoagulation use. There were no differences in tumor locations, cavernous sinus invasion, or tumor volumes (6.84 ± 4.61 vs. 9.15 ± 8.45 cm, p = 0.5). Patients with recurrent apoplexy were less likely to present with headache (27.3%) or ophthalmoplegia (9.1%). Recurrent apoplexy was associated with prior radiation (0.0 vs. 27.3%, p = 0.0001) and prior subtotal resection (10.6 vs. 90.9%, p = 0.0001) compared with first time apoplexy. The mean time to recurrent apoplexy was 48.3 ± 76.9 months and no differences in overall follow-up were seen in this group. Conclusion Recurrent pituitary apoplexy represents a rare event with limited understanding of pathophysiology. Prior STR and radiation treatment are associated with an increased risk. The relatively long time from the first apoplectic event to a recurrence suggests long-term patient follow-up is necessary.

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