scholarly journals Stroke Mimics on the Stroke Unit – Temporal trends 2008–2017 at a large Norwegian university hospital

2021 ◽  
Author(s):  
Mathias Barra ◽  
Kashif Waqar Faiz ◽  
Fredrik Andreas Dahl ◽  
Halvor Næss
Keyword(s):  
Stroke Unit ◽  
Temporal Trends ◽  
University Hospital ◽  
Stroke Mimics

scholarly journals Trends in the treatment of risk factors for stroke in a Czech stroke unit

Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Libor Simunek ◽  
Dagmar Krajickova ◽  
Oldrich Vysata ◽  
Martin Valis
Keyword(s):  
Risk Factors ◽  
Stroke Unit ◽  
Stroke Risk ◽  
Beta Blockers ◽  
University Hospital ◽  
Stroke Recurrence ◽  
Channel Blockers ◽  
Motivation To Change ◽  
The University ◽  
Insulin Use

AbstractThe goal of this study is to evaluate therapeutic trends for several diseases that represent risk factors for stroke. The relative frequency of therapy with compounds that influence the risk factors for stroke was monitored in a group of 3,290 patients who were hospitalised in the Stroke Unit at the University Hospital in Hradec Kralove between 2005 and 2012. For most drugs monitored, the reasons for the significant decrease or increase in use were causes other than the reduction of stroke risk. Despite this finding, the majority of statistically significant changes had, according to review of comparative studies, a posi- tive effect on prevention of stroke. Motivation to change treatment of stroke risk factors, such as hypertension, diabetes mellitus and hypercholesterolemia, was mainly aimed at sufficient disease management with a minimum of adverse effects. On the other hand, optimization of stroke recurrence and economic factors were motivations to treatment changes in prevention with antiplatelets. Antidiabetics were associated with an increase in met- formin use and reduction in insulin use. For antihyperten- sives, the most significant reduction was associated with the use of diuretics, although calcium channel blockers and beta-blockers are also less used. Additionally, the use of the ACE inhibitor ramipril increased

Abstract WP72: Early Experience on Intravenous Tissue Plasminogen Activator Delivery in Mobile Stroke Unit Patients with Stroke Mimics

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lila E Sheikhi ◽  
Stacey Winners ◽  
Pravin George ◽  
Andrew Russman ◽  
Zeshaun Khawaja ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Early Experience ◽  
Final Diagnosis ◽  
Stroke Mimics ◽  
Intravenous Tissue Plasminogen Activator ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background: A mobile stroke unit (MSU) allows for early delivery for intravenous tissue plasminogen activator (IV-tPA). A proportion of IV-tPA treated patients may turn out to be stroke mimics. We evaluated the rate and complications seen in stroke mimics treated with tPA from our early experience on MSU. Methods: Retrospective review of patients treated with IV-tPA on the MSU from 2014 to 2016. Charts were reviewed for confirmed strokes by imaging (MRI or CT) and hemorrhagic transformation. Stroke mimics were defined as those without imaging evidence of infarction and a final diagnosis which was not suspected to be stroke. Results: Among 62 patients treated with IV-tPA, 14 (28.6%) had a final diagnosis consistent with a stroke mimics. The majority of these occurred in the first year of the MSU program. Most common mimics included conversion disorder (n=5) and seizures (n=5). While the last known well to IV-tPA times were similar, the MSU door-to-needle time was significantly longer in stroke mimics (38 vs 31 minutes, p = 0.03). No intracerebral hemorrhages or other IV-tPA related complications were identified in the stroke mimics group. Conclusions: In our early experience with MSU, treatment of stroke mimics occurred without IV-tPA related complications. This does not appear to be due to rushed decision making.

Abstract TP187: Low Sensitivity and High Specificity of Administrative Data for Transient Ischemic Attacks in the Emergency Department

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Amy Y Yu ◽  
Hude Quan ◽  
Andrew McRae ◽  
Gabrielle O Wagner ◽  
Shelagh B Coutts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Administrative Data ◽  
Temporal Trends ◽  
High Specificity ◽  
Reference Standards ◽  
Administrative Database ◽  
Minor Stroke ◽  
Stroke Mimics ◽  
Icd 10 ◽  
Low Sensitivity

Introduction: Accurate surveillance of TIA is important for monitoring disease burden and evaluating temporal trends. Passive surveillance is a time and cost-effective method to identify TIA using administrative data. Although TIA is primarily managed in the emergency department (ED) without admission to hospital, prior administrative data validation studies have mainly evaluated inpatient databases. We determined the validity of the ICD-10 codes to identify TIA in an ED administrative database. Methods: The study population was obtained from two ongoing studies on the diagnosis of TIA and minor stroke versus stroke mimic. Stroke mimics were actively recruited. Patients enrolled between December 1st 2013 and October 30th 2015 with an ED visit were included in the current study. ED discharge diagnoses were obtained from the National Ambulatory Care Reporting System database. We determined the sensitivity, specificity, and positive predictive value (PPV) of the ICD-10 TIA codes by using two reference standards: 1) the ED chart abstraction and 2) the 90-day final diagnosis, both adjudicated by stroke neurologists. Different case definition algorithms were tested. Results: We included 417 patients. ED adjudication showed 163 (39.1%) TIA, 155 (37.2%) ischemic stroke, and 99 (23.7%) stroke mimics. The most restrictive algorithm, defined as a TIA code in the main position had the lowest sensitivity (36.8%), but highest specificity (92.5%) and PPV (76.0%). The most inclusive algorithm, defined as a TIA code in any positions with and without query prefix had the highest sensitivity (63.8%), but lowest specificity (81.5%) and PPV (68.9%). Comparing the final 90-day diagnosis with coding showed similar results. Conclusions: TIA can be identified with high specificity, but low sensitivity from ED discharge diagnoses. By including patients with stroke mimics, we determined both the false positive and negative rates, allowing for the calculation of sensitivity and specificity. We used two reference standards to verify the accuracy of administrative data. Future studies are necessary to understand the reasons for the low sensitivity of administrative data for TIA and whether the miscoded patients are systematically different from the accurately coded ones.

Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit

2015 ◽  
Vol 88 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Sergios Gargalas ◽  
Robert Weeks ◽  
Najma Khan-Bourne ◽  
Paul Shotbolt ◽  
Sara Simblett ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Mimics ◽  
Hyperacute Stroke

Changes Related To Inpatient Mortality From Acute Stroke In The Stroke Unit Of The Klaipeda University Hospital In 2007-2015

2016 ◽  
Vol 26 (5) ◽  
pp. 74-78
Author(s):  
Henrikas Kazlauskas ◽  
Elena Bovina ◽  
Geriuldas Žiliukas
Keyword(s):  
Acute Stroke ◽  
Odds Ratio ◽  
Stroke Unit ◽  
Hemorrhagic Stroke ◽  
Age Groups ◽  
University Hospital ◽  
Inpatient Mortality ◽  
Significant Difference ◽  
Icd 10 ◽  
Stroke Type

The aim of the study was to analyse the changes in inpatient mortality from acute stroke in the stroke unit of the Klaipeda University Hospital in 2007- 2015. Medical history data of 265 patients who died from acute stroke in the stroke unit were analysed. Inpatient mortality rate was calculated among all patients diagnosed with acute stroke who were treated in the stroke unit during the entire study period. The number of deaths in different age groups (up until 65; 65 and older) and comorbidities in patients who died from acute stroke were analysed, depending on stroke type in different treatment periods (2007-2011 and 2012-2015). The International Classification of Diseases, Tenth Revision (ICD-10), Codes I60-I64 were used to diagnose different stroke types in 2007-2011, while ICD-10 AM, Codes I60-I64 were used in 2012- 2015. The statistical analysis was performed using SPSS 17.0 for Windows. Chi-squared (χ2) criterion and Fisher’s exact test were used for small samples to evaluate dependency and homogeneity of qualitative characteristics. The difference between them was considered as statistically significant at p <0.05. Data are presented as a percentage. Student’s t-test was applied for average age comparison. Odds ratio (OR), reflecting the mortality from acute stroke in different periods, was established. The comparison of the two study periods revealed the decrease in patients who died from acute stroke - from 7.0% (2007-2011) to 4,3 % (2012-2015), (p<0.001). Mortality from ischemic and hemorrhagic stroke was similar. The analysis showed significant age difference (p=0.007) among patients who died from acute stroke: in the later study period (2012-2015), the patients were older than those who died in the earlier period; however, no significant difference was observed when analysing them by age groups (up until 65; 65 and older). The odds of dying in 2007- 2011 were 1.69 times higher than in 2012-2015 (p<0.001), whereas the odds ratio for ischemic stroke in 2007-2011 was 1.75 times higher than in 2012- 2015 (p<0.0001). No significant difference between different study periods was established when analysing the changes in the number of comorbidities in patients who died from acute stroke. The assesment of differences in comorbidities depending on the stroke type revealed that significantly more patients who died from ischemic stroke had been diagnosed with coronary heart disease (CHD) (including angina pectoris (AP) and atrial fibrillation (AF)) than those who died from hemorrhagic stroke. It was concluded that, when comparing the two study periods, the number of patients who died from acute stroke decreased significantly - from 7.0% (2007- 2011) to 4.3% (2012-2015) (p<0.001). The odds ratio for dying from acute stroke in 2007-2011 was established to be significantly higher than in 2012- 2015 and patients who died from acute stroke in the later study period were significantly older.

scholarly journals Temporal Trends in Gestational Diabetes Prevalence, Treatment, and Outcomes at Aarhus University Hospital, Skejby, between 2004 and 2016

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Per Glud Ovesen ◽  
Jens Fuglsang ◽  
Mette Bisgaard Andersen ◽  
Charlotte Wolff ◽  
Olav Bjørn Petersen ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Diabetes ◽  
Insulin Therapy ◽  
Gestational Age ◽  
Temporal Trends ◽  
University Hospital ◽  
Large For Gestational Age ◽  
Z Score ◽  
Glucose Levels ◽  
Obesity And Diabetes

Background. The prevalence of gestational diabetes (GDM) is increasing worldwide. The most important risk of GDM in pregnancy is excessive fetal growth, increasing the risk of complications during delivery as well as long-term complications like obesity and diabetes in both the mother and the offspring. Method. All women with GDM who delivered a singleton between 2004 and 2016 were included. The treatment of GDM patients sought to achieve normal blood glucose levels, primarily by diet and exercise. If the glycemic targets were not reached, insulin therapy was initiated. Birth weight and birth weight Z-score was calculated corrected for gender and gestational age at delivery. Results. The study included 1910 women. The number of GDM women increased significantly each year over the course of the study, as did the proportion requiring insulin therapy. Birth weight and birth weight Z-score fell significantly over the years largely due to a decrease in large for gestational age frequency from 29% to around 19%. Conclusion. During the last 13 years, the number of women diagnosed with GDM has increased. Furthermore, the proportion of GDM women receiving insulin treatment has increased. The birth weight in diet-treated women has been virtually normal for the last 5 years of the reported period.

scholarly journals A register-based study comparing planned rehabilitation following acute stroke in 2011 and 2017

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Malin C. Nylén ◽  
Hanna C. Persson ◽  
Tamar Abzhandadze ◽  
Katharina S. Sunnerhagen
Keyword(s):  
Stroke Unit ◽  
Community Hospital ◽  
Binary Logistic Regression ◽  
University Hospital ◽  
Impaired Consciousness ◽  
University Hospitals ◽  
Cross Sectional ◽  
Severe Stroke ◽  
Stroke Units ◽  
Explanatory Variables

AbstractThis cross-sectional, register-based study aimed to explore patterns of planned rehabilitation at discharge from stroke units in Sweden in 2011 and 2017 and identify explanatory variables for planned rehabilitation. Multivariable binary logistic regression was used to identify variables that could explain planned rehabilitation. There were 19,158 patients in 2011 and 16,508 patients in 2017 with stroke, included in the study. In 2011, 57% of patients were planned for some form of rehabilitation at discharge from stroke unit, which increased to 72% in 2017 (p < 0.001). Patients with impaired consciousness at admission had increased odds for planned rehabilitation (hemorrhage 2011 OR 1.43, 95% CI 1.13–1.81, 2017 OR 1.66, 95% CI 1.20–2.32), (IS 2011 OR 1.21, 95% CI 1.08–1.34, 2017 OR 1.49, 95% CI 1.28–1.75). Admission to a community hospital (hemorrhage 2011 OR 0.56, 95% CI 0.43–0.74, 2017 OR 0.39, 95% CI 0.27–0.56) (IS 2011 OR 0.63, 95% CI 0.58–0.69, 2017 OR 0.54, 95% CI 0.49–0.61) or to a specialized non-university hospital (hemorrhage 2017 OR 0.66, 95% CI 0.46–0.94), (IS 2011 OR 0.90, 95% CI 0.82–0.98, 2017 OR 0.76, 95% CI 0.68–0.84) was associated with decreased odds of receiving planned rehabilitation compared to admission to a university hospital. As a conclusion severe stroke was associated with increased odds for planned rehabilitation and patients discharged from non-university hospitals had consistently decreased odds for planned rehabilitation.

Sex-specific temporal trends in the incidence of atrial fibrillation in a large Norwegian population-based study 1986–2014

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Sharashova ◽  
T Wilsgaard ◽  
J Ball ◽  
E Gerdts ◽  
A Rosengren ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Linear Time ◽  
Population Aging ◽  
Temporal Trends ◽  
Population Based ◽  
Incidence Rates ◽  
University Hospital ◽  
Funding Source

Abstract Background Due to population aging, increasing prevalence of obesity and enhanced detection, the prevalence of atrial fibrillation (AF) worldwide is increasing steadily. Considerable sex differences in the epidemiology of AF such as lower prevalence and later onset in women compared to men have been reported. However, little is known about sex-specific temporal trends in AF incidence within the general population. Purpose To explore sex-specific age-adjusted secular trends in the incidence of AF in a general population from Norway between 1986 and 2014. Methods A total of 16,865 men and 15,413 women aged 20 years or older and without AF were enrolled in a longitudinal population study between 1986 and 2008 and followed up for incident AF to the end of 2014. Follow-up was from the date of attendance to the date of AF, emigration or death, whichever came first. All AF cases were validated by an independent endpoint committee using hospital and death records. AF incidence rates were calculated for each calendar year by dividing the number of AF cases per year by the corresponding person-time at risk. To allow for non-linear time trends, calendar year was fitted using fractional polynomials. Poisson regression was used to estimate calendar year-specific AF incidence rates adjusted for age. All analyses were stratified by sex. Results A total of 911 AF events in women and 1,139 AF events in men occurred over 324,090 person-years and 294,531 person-years of follow-up, respectively. During the study period AF incidence rates in men were at least double that in women (Figure). Age-adjusted AF incidence rates in women increased from 1986, peaked at 0.87 per 1000 person-years in 1998 and then decreased slightly towards 2014. In men AF incidence rates increased up to 2.18 per 1000 person-years in 2005 and then steeply decreased. Conclusion(s) AF incidence rates decreased in both women and men towards the end of the study period. The decrease was more profound in men compared to that in women. One possible explanation is more pronounced reduction in incidence and better treatment of myocardial infarction in men compared to women given that the aetiology of AF in men is mainly ischemic heart disease-related. However, further epidemiological analyses should be undertaken to identify explanatory factors. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University Hospital of North Norway, Northern Norway Regional Health Authority

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