scholarly journals Population-based stroke surveillance using Big Data: epidemiological trends in admissions and mortality in Australia

2020 ◽  
Author(s):  
Melina Gattellari ◽  
Chris Goumas ◽  
Bin Jalaludin ◽  
John M. Worthington
Keyword(s):  
Confidence Interval ◽  
Subarachnoid Haemorrhage ◽  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Negative Binomial ◽  
Stroke Care ◽  
Percentage Change ◽  
Post Discharge ◽  
Average Percentage ◽  
Epidemiological Trends

AbstractBackgroundEpidemiological trends for major causes of death and disability, such as stroke, may be monitored using administrative data to guide public health initiatives and service delivery.MethodsWe calculated admissions rates for ischaemic stroke, intracerebral haemorrhage or subarachnoid haemorrhage between January 1, 2005 and December 31st, 2013 and rates of 30-day mortality and 365-day mortality in 30-day survivors to December 31st 2014 for patients aged 15 years or older from New South Wales, Australia (population 7.99 million). Annual Average Percentage Change in rates was estimated using negative binomial regression.ResultsOf 81,703 eligible admissions, 64,047 (78.4%) were ischaemic strokes and 13,302 (16.3%) and 4,778 (5.8%) were intracerebral and subarachnoid haemorrhages, respectively. Intracerebral haemorrhage admissions significantly declined by an average of 2.2% annually (95% Confidence Interval=-3.5% to −0.9%) (p<0.001). Thirty-day mortality rates significantly declined for ischaemic stroke (Average Percentage Change −2.9%, 95% Confidence Interval=-5.2% to −1.0%) (p=0.004) and subarachnoid haemorrhage (Average Percentage Change=-2.6%, 95% Confidence Interval=-4.8% to −0.2%) (p=0.04). Mortality at 365-days amongst 30-day survivors of ischaemic stroke and intracerebral haemorrhage was stable over time and increased in 30-day survivors of subarachnoid haemorrhage (Annual Percentage Change 6.2%, 95% Confidence Interval=-0.1% to 12.8%), although the increase was not statistically significant (p=0.05).ConclusionImproved prevention may have underpinned declining intracerebral haemorrhage rates while gains in survival suggest that innovations in stroke care are being successfully translated. Longer-term mortality in patients surviving the acute period is unchanged and may be increasing for subarachnoid haemorrhage warranting investment in post-discharge care and secondary prevention.

scholarly journals Reducing the severity of stroke

2019 ◽  
Vol 95 (1123) ◽  
pp. 271-278 ◽  
Author(s):  
Georgina Meredith ◽  
Anthony Rudd
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Treatment ◽  
Causes Of Death ◽  
Stroke Care ◽  
Stroke Patients ◽  
Advanced Imaging ◽  
Effective Prevention

Stroke remains one of the most important causes of death and disability worldwide. Effective prevention could reduce the burden of stroke dramatically. The management of stroke has undergone a revolution over the last few decades, particularly with the development of techniques for revascularisation of patients with ischaemic stroke. Advanced imaging able to identify potentially salvageable brain is further increasing the potential for effective acute treatment. However, the majority of stroke patients won’t benefit from these treatments and will need effective specialist stroke care and ongoing rehabilitation to overcome impairments and adapt to living with a disability. There are still many unanswered questions about the most effective way of delivering rehabilitation. Likewise, research into how to manage primary intracerebral haemorrhage has yet to transform care.

Cerebral haemorrhage

2017 ◽  
Author(s):  
Hugh Markus ◽  
Anthony Pereira ◽  
Geoffrey Cloud
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Ischaemic Stroke ◽  
Brain Imaging ◽  
Intracerebral Haemorrhage ◽  
Cerebral Haemorrhage ◽  
Neurological Disability

This chapter covers the several types of cerebral haemorrhage: extradural, subdural, subarachnoid, and intracerebral. Subarachnoid haemorrhage (SAH) is an important cause of neurological disability and mortality, although only occasionally present with focal stroke symptoms. Intracerebral haemorrhage usually presents with a stroke, which can only be reliably distinguished from ischaemic stroke by brain imaging. The chapter discusses the diagnosis, investigation, and management of both SAH and intracerebral haemorrhage.

P2780Accuracy of electronic healthcare records for diagnosis of stroke types in a large community-based prospective cohort study in China

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I J Turnbull ◽  
R Clarke ◽  
Y Guo ◽  
A Hacker ◽  
C Kartsonaki ◽  
...  
Keyword(s):  
Cohort Study ◽  
Subarachnoid Haemorrhage ◽  
Diagnostic Accuracy ◽  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Medical Records ◽  
Community Based ◽  
Health Records ◽  
Large Community ◽  
Stroke Type

Abstract Background and purpose Reliable assessment of the determinants of major pathological types of stroke is dependent on the accuracy of diagnosis in population-based studies. We evaluated the diagnostic accuracy of stroke types in a large community-based cohort study involving health records collected in China. Methods In 2004–08, >0.5 million adults aged 30–79 years were recruited from general populations of 10 diverse areas (5 urban, 5 rural) in China. During an approximate 7-year follow-up, 37,694 stroke cases had been reported by linkage to electronic health records from disease-specific and mortality registries and from national health insurance agencies. For all reported stroke cases, hospital medical records were retrieved systematically and relevant data extracted for subsequent adjudication by specialists using bespoke electronic platforms. Results Among all reported incident stroke cases, 80% were ischaemic stroke (IS), 17% were intracerebral haemorrhage (ICH), and 1% were subarachnoid haemorrhage (SAH). To date, medical records have been retrieved for 29,632 cases, with reports of stroke diagnosis verified by public health staff in 27,115 (92%) cases, of which 3,778 (14%) were secondary diagnoses. Evidence of neuroimaging was found in 92% of all verified stroke cases. Of 23,337 primary stroke cases sent for specialist adjudication, a diagnosis of pathological stroke type was confirmed in 19,718 cases with the positive predictive values being 82.4% (95% confidence interval [CI], 82.0% - 82.8%) for IS, 97.8% (97.6 - 97.9) for ICH, and 98.2% (98.1 - 98.3) for SAH. Overall, the strength of association of systolic blood pressure was over 6-fold greater for confirmed than non-confirmed stroke cases and was nearly 3-fold greater for confirmed ICH than IS cases. Diagnostic accuracy by stroke type Reported Retrieved Verified Adjudicated Confirmed Approximate 95% CI n n % n % n % n PPV, % IS 30,143 25,477 85 23,551 92 20,045 85 16,515 82.4 (82.0–82.8) ICH 6,484 3,486 54 3,079 88 2,919 95 2,854 97.8 (97.6–97.9) SAH 557 397 71 326 82 279 86 274 98.2 (98.1–98.3) Other 510 272 53 159 59 94 59 75 79.8 (79.4–80.2) IS indicates ischaemic stroke; ICH, intracerebral haemorrhage; SAH, subarachnoid haemorrhage; and PPV, positive predictive value. Conclusions The overall diagnostic accuracy of pathological stroke types obtained from hospital records in China is comparable to reports from Western populations. Despite advances in electronic healthcare records, reliable classification of stroke types requires clinical adjudication using additional relevant investigations. Acknowledgement/Funding Kadoorie Charitable Foundation, UK Wellcome Trust & National Natural Science Foundation and National Key Research and Development Program of China

scholarly journals Measuring stroke outcomes using linked administrative data: Population-based estimates and validation of “home-time” as a surrogate measure of functional status

2019 ◽  
Author(s):  
Melina Gattellari ◽  
Chris Goumas ◽  
Bin Jalaludin ◽  
John Worthington
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Ischaemic Stroke ◽  
Administrative Data ◽  
Negative Binomial ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Population Based ◽  
Initial Contact ◽  
Hospital Data ◽  
At Home

AbstractBackgroundAdministrative data offer cost-effective, whole-of-population stroke surveillance yet the lack of validated outcomes is a short-coming. The number of days spent living at home after stroke (“home-time”) is a patient-centred outcome that can be objectively ascertained from administrative data. Population-based validation against both severity and outcome measures and for all subtypes is lacking.MethodsStroke hospitalisations from a state-wide census in New South Wales, Australia, from July 1, 2005 to March 31, 2014 were linked to pre-hospital data, post-stroke admissions and deaths. We calculated correlations between 90-day home-time and Glasgow Coma Scale (GCS) scores, measured upon a patient’s initial contact with paramedics, and Functional Independence Measure (FIM) scores, measured upon entry to rehabilitation after the acute hospital stroke admission. Negative binomial regression models were used to identify predictors of home-time.ResultsPatients with stroke (N=74,501) spent a median of 53 days living at home after the event. Median home-time was 60 days after ischaemic stroke, 49 days after subarachnoid haemorrhage and 0 days after intracerebral haemorrhage. GCS and FIM scores significantly correlated with home-time (p-values<0.001). Female sex predicted less home-time in ischaemic stroke, while being married increased home time after ischaemic stroke and subarachnoid haemorrhage.ConclusionsHome-time measured using administrative data is a robust, replicable and valid patient-centred outcome enabling inexpensive population-based surveillance.

Neurological disorders

2019 ◽  
pp. 393-430
Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Critical Illness ◽  
Subarachnoid Haemorrhage ◽  
Myasthenia Gravis ◽  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Neurological Disorders ◽  
De Novo

This chapter discusses neurological disorders and includes discussion on delirium, status epilepticus, meningitis and encephalitis, intracerebral haemorrhage, subarachnoid haemorrhage, ischaemic stroke, Guillain–Barré syndrome, myasthenia gravis, intensive care unit-acquired weakness, tetanus, botulism, rehabilitation and critical illness, and hyperthermias. The aim is to provide a summary of the extensive complex neuological pathologies that can present to an intensive care clinician. Where appropriate, descriptions are provided on clinical presentation, epidemiology, diagnosis (including investigations), and management. Of note, some of the conditions covered can arise on the ward or prehospital environments with subsequent requirement for intensive care, but they can also arise de novo on the intensive care unit itself, highlighting the need for intensive care clinicians to maintain a broad knowledge and understanding of their presentation and management.

scholarly journals Background incidence rates of hospitalisations and emergency department visits for thromboembolic and coagulation disorders in Ontario, Canada for COVID-19 vaccine safety assessment: a population-based retrospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052019
Author(s):  
Sharifa Nasreen ◽  
Andrew J Calzavara ◽  
Maria E Sundaram ◽  
Shannon E MacDonald ◽  
Christiaan H Righolt ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Subarachnoid Haemorrhage ◽  
Venous Thrombosis ◽  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Cerebral Venous Thrombosis ◽  
Emergency Department Visits ◽  
Vein Thrombosis ◽  
Deep Vein

ObjectiveThe objective of this study was to estimate background rates of selected thromboembolic and coagulation disorders in Ontario, Canada.DesignPopulation-based retrospective observational study using linked health administrative databases. Records of hospitalisations and emergency department visits were searched to identify cases using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada diagnostic codes.ParticipantsAll Ontario residents.Primary outcome measuresIncidence rates of ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, deep vein thrombosis, pulmonary embolism, idiopathic thrombocytopaenia, disseminated intravascular coagulation and cerebral venous thrombosis during five prepandemic years (2015–2019) and 2020.ResultsThe average annual population was 14 million with 51% female. The mean annual rates per 100 000 population during 2015–2019 were 127.1 (95% CI 126.2 to 127.9) for ischaemic stroke, 22.0 (95% CI 21.6 to 22.3) for intracerebral haemorrhage, 9.4 (95% CI 9.2 to 9.7) for subarachnoid haemorrhage, 86.8 (95% CI 86.1 to 87.5) for deep vein thrombosis, 63.7 (95% CI 63.1 to 64.3) for pulmonary embolism, 6.1 (95% CI 5.9 to 6.3) for idiopathic thrombocytopaenia, 1.6 (95% CI 1.5 to 1.7) for disseminated intravascular coagulation, and 1.5 (95% CI 1.4 to 1.6) for cerebral venous thrombosis. Rates were lower in 2020 than during the prepandemic years for ischaemic stroke, deep vein thrombosis and idiopathic thrombocytopaenia. Rates were generally consistent over time, except for pulmonary embolism, which increased from 57.1 to 68.5 per 100 000 between 2015 and 2019. Rates were higher for females than males for subarachnoid haemorrhage, pulmonary embolism and cerebral venous thrombosis, and vice versa for ischaemic stroke and intracerebral haemorrhage. Rates increased with age for most of these conditions, but idiopathic thrombocytopaenia demonstrated a bimodal distribution with incidence peaks at 0–19 years and ≥60 years.ConclusionsOur estimated background rates help contextualise observed events of these potential adverse events of special interest and to detect potential safety signals related to COVID-19 vaccines.

Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost–utility analysis for a middle income country

2021 ◽  
pp. 1357633X2110324
Author(s):  
Elise Tan ◽  
Lan Gao ◽  
Huong NQ Tran ◽  
Dominique Cadilhac ◽  
Chris Bladin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Rural China ◽  
Stroke Care ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Sensitivity Analyses ◽  
Economic Evaluations ◽  
Utility Analysis

Introduction Telemedicine can alleviate the problems faced in rural settings in providing access to specialist stroke care. The evidence of the cost-effectiveness of this model of care outside high-income countries is limited. This study aimed to conduct: (a) a systematic review of economic evaluations of telestroke and (b) a cost–utility analysis of telestroke, using China as a case study. Methods We systematically searched Embase, Medline Complete and Cochrane databases. Inclusion criteria: full economic evaluations of telemedicine/telestroke networks examining the use of thrombolysis in patients with acute ischaemic stroke, published in English. A cost–utility analysis was undertaken using a Markov model incorporating a decision tree to simulate the delivery of telestroke for acute ischaemic stroke in rural China, compared to no telestroke from a societal and healthcare perspective. One-way deterministic sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of results. Results Of 559 publications found, eight met the eligibility criteria and were included in the systematic review (two cost-effectiveness analyses and six cost–utility analyses, all performed in high-income countries). Telestroke was a cost-saving/cost-effective intervention in five out of the eight studies. In our modelled analysis for rural China, telestroke was the dominant strategy, with estimated cost savings of Chinese yuan 4,328 (US$627) and additional 0.0925 quality-adjusted life years per patient. Sensitivity analyses confirmed the base case results. Discussion Consistent with published economic evaluations of telestroke in other jurisdictions, telestroke represents a cost-effective solution to enhance stroke care in rural China.

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