The influence of sex on ischemic stroke incidence, therapeutic procedures and in‐hospital mortality: Results of the Spanish National Hospital Discharge

2021 ◽  
Author(s):  
José M. Miguel‐Yanes ◽  
Rodrigo Jiménez‐García ◽  
Ana López‐de‐Andrés ◽  
Valentín Hernández‐Barrera ◽  
Javier Miguel‐Díez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Discharge ◽  
National Hospital ◽  
Stroke Incidence ◽  
Therapeutic Procedures

scholarly journals Sex-Related Disparities in the Incidence and Outcomes of Ischemic Stroke among Type 2 Diabetes Patients. A Matched-Pair Analysis Using the Spanish National Hospital Discharge Database for Years 2016–2018

2021 ◽  
Vol 18 (7) ◽  
pp. 3659
Author(s):  
Ana López-de-Andrés ◽  
Rodrigo Jimenez-Garcia ◽  
Valentin Hernández-Barrera ◽  
Isabel Jiménez-Trujillo ◽  
José J. Zamorano-León ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Ischemic Stroke ◽  
Hospital Discharge ◽  
Incidence Rates ◽  
Matched Pair ◽  
National Hospital ◽  
Matched Pair Analysis ◽  
Therapeutic Procedures ◽  
Pair Analysis

Background: To analyze the incidence, use of therapeutic procedures, and in-hospital outcomes among patients suffering an ischemic stroke (IS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the existence of sex differences. Methods: Matched-pair analysis using the Spanish National Hospital discharge. Results: IS was coded in 92,524 men and 79,731 women (29.53% with T2DM). The adjusted incidence of IS (IRR 2.02; 95% CI 1.99–2.04) was higher in T2DM than non-T2DM subjects, with higher IRRs in both sexes. Men with T2DM had a higher incidence of IS than T2DM women (IRR 1.54; 95% CI 1.51–1.57). After matching patients with T2DM, those with other comorbid conditions, however, significantly less frequently received endovascular thrombectomy and thrombolytic therapy. In-hospital mortality (IHM) was lower among T2DM men than matched non-T2DM men (8.23% vs. 8.71%; p < 0.001). Women with T2DM had a higher IHM rate than T2DM men (11.5% vs. 10.20%; p = 0.004). After adjusting for confounders, women with T2DM had a 12% higher mortality risk than T2DM men (OR 1.12; 95% CI 1.04–1.21). Conclusions: T2DM is associated with higher incidence of IS in both sexes. Men with T2DM have a higher incidence rates of IS than T2DM women. Women with T2DM have a higher risk of dying in the hospital.

scholarly journals Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window

2021 ◽  
Vol 12 ◽  
Author(s):  
Erik Simon ◽  
Matin Forghani ◽  
Andrij Abramyuk ◽  
Simon Winzer ◽  
Claudia Wojciechowski ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Functional Outcome ◽  
Hospital Discharge ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Short Term ◽  
Discharge Disposition ◽  
Favorable Functional Outcome

Background: While intravenous thrombolysis (IVT) in ischemic stroke can be safely applied in telestroke networks within 3 h from symptom onset, there is a lack of evidence for safety in the expanded 3- to 4. 5-h time window. We assessed the safety and short-term efficacy of IVT in acute ischemic stroke (AIS) in the expanded time window delivered through a hub-and-spoke telestroke network.Methods: Observational study of patients with AIS who received IVT at the Stroke Eastern Saxony Telemedical Network between 01/2014 and 12/2015. We compared safety data including symptomatic intracerebral hemorrhage (sICH; according to European Cooperative Acute Stroke Study II definition) and any intracerebral hemorrhage (ICH) between patients admitted to telestroke spoke sites and patients directly admitted to a tertiary stroke center representing the hub of the network. We also assessed short-term efficacy data including favorable functional outcome (i.e., modified Rankin Scale ≤ 2) and National Institutes of Health Stroke Scale (NIHSS) at discharge, hospital discharge disposition, and in-hospital mortality.Results: In total, 152 patients with AIS were treated with IVT in the expanded time window [spoke sites, n = 104 (26.9%); hub site, n = 48 (25.9%)]. Patients treated at spoke sites had less frequently a large vessel occlusion [8/104 (7.7) vs. 20/48 (41.7%); p &lt; 0.0001], a determined stroke etiology (p &lt; 0.0001) and had slightly shorter onset-to-treatment times [210 (45) vs. 228 (58) min; p = 0.02] than patients who presented to the hub site. Both cohorts did not display any further differences in demographics, vascular risk factors, median baseline NIHSS scores, or median baseline Alberta stroke program early CT score (p &gt; 0.05). There was no difference in the frequency of sICH (4.9 vs. 6.3%; p = 0.71) or any ICH (8.7 vs. 16.7%; p = 0.15). Neither there was a difference regarding favorable functional outcome (44.1 vs. 39.6%; p = 0.6) nor median NIHSS [3 (5.5) vs. 2.5 (5.75); p = 0.92] at discharge, hospital discharge disposition (p = 0.28), or in-hospital mortality (9.6 vs. 8.3%; p = 1.0). Multivariable modeling did not reveal an association between telestroke and sICH or favorable functional outcome (p &gt; 0.05).Conclusions: Delivery of IVT in the expanded 3- to 4.5-h time window through a telestroke network appears to be safe with equivalent short-term functional outcomes for spoke-and-hub center admissions.

Abstract MP90: Validity of Hospital Discharge Diagnosis Codes for Stroke: Evaluation of New American Heart Association/American Stroke Association Definitions

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Sydney Jones ◽  
Rebecca F Gottesman ◽  
Eyal Shahar ◽  
Lisa Wruck ◽  
Wayne D Rosamond
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Ct Scan ◽  
Hospital Discharge ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Administrative Claims ◽  
Stroke Incidence ◽  
Study Sites

Background: Characterizing International Classification of Disease (ICD-9) code validity is essential given widespread use of hospital discharge and claims databases in research. Estimates for acute stroke vary depending on the codes investigated. We sought to estimate the validity of ICD-9 codes grouped according to the 2013 American Heart Association/ American Stroke Association (AHA/ASA) updated stoke definition and to explore differences by patient characteristics and study site. Methods: Medical records (N=4,260) containing ICD-9 codes 430-438 or stroke keywords in the discharge summary were abstracted for hospitalizations of Atherosclerosis Risk in Communities (ARIC) Study cohort members from 1987-2010. A computer algorithm and physician reviewer identified definite and probable ischemic stroke, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) with differences adjudicated by a second physician. Using ARIC diagnosis as a gold standard, we calculated the positive predictive value (PPV) and sensitivity of groups of ICD-9 codes matched to stroke subtypes by the AHA/ASA (ischemic stroke: 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91; ICH: 431; SAH: 430). We excluded codes for spinal and retinal infarcts (336.1, 362.31, 362.32), which were not validated in ARIC (N=3 events). Results: Thirty-three percent of 4,260 hospitalizations were validated as definite or probable strokes (1,251 ischemic, 120 ICH, 46 SAH), and 30% (1,276 of 4,260) of hospitalizations included ICD-9 codes identified by the AHA/ASA. The AHA/ASA code groups had PPV 76% and 68% sensitivity, compared to PPV 40% and 95% sensitivity for ICD-9 codes 430-438 (not 435) traditionally used to identify stroke. For ischemic stroke, AHA/ASA identified ICD-9 codes were present for 1,043 hospitalizations. Among these, PPV was 76% overall and was slightly higher for blacks (80%, N=400) compared to whites (74%, N=643; p=0.04). However, differences by race diminished conditional undergoing a CT scan or MRI (blacks 81%, N=390; whites 78%, N=601). Among whites, PPV for ischemic stroke ranged from 60-79%, and sensitivity ranged from 60-70% across study sites. ICD-9 codes 430-431 for ICH and SAH were present for 225 hospitalizations and had PPV 61%. PPV was higher among blacks (73%, N=89) compared to whites (53%, N=136; p=0.003), and differences by race were not diminished conditional on undergoing a CT scan or MRI. Among whites, PPV for ICH and SAH ranged from 38-60%, and sensitivity ranged from 78-89% across study sites. Conclusion: New AHA/ASA code groups had higher PPV but lower sensitivity for identifying acute stroke than a traditional code group. PPV was higher among blacks compared to whites and both PPV and sensitivity varied by study site. These data may be useful for calibrating estimates of stroke incidence generated from administrative claims data and in sensitivity analyses.

Thrombolysis for Ischemic Stroke in the United States: Data from National Hospital Discharge Survey 1999–2001

Neurosurgery ◽  
2005 ◽  
Vol 57 (4) ◽  
pp. 647-654 ◽  
Author(s):  
Adnan I. Qureshi ◽  
M Fareed K. Suri ◽  
Abu Nasar ◽  
Wei He ◽  
Jawad F. Kirmani ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Hospital Discharge ◽  
The United States ◽  
National Hospital ◽  
National Hospital Discharge Survey ◽  
States Data

scholarly journals Can Hospital Discharge Databases Be Used to Follow Ischemic Stroke Incidence?

Stroke ◽  
2013 ◽  
Vol 44 (7) ◽  
pp. 1770-1774 ◽  
Author(s):  
Julie Haesebaert ◽  
Anne Termoz ◽  
Stéphanie Polazzi ◽  
Christelle Mouchoux ◽  
Laura Mechtouff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Discharge ◽  
Stroke Incidence

scholarly journals Trends in Hospital Admission for Stroke in Calgary

2004 ◽  
Vol 31 (3) ◽  
pp. 387-393 ◽  
Author(s):  
T.S. Field ◽  
T.L. Green ◽  
K. Roy ◽  
J. Pedersen ◽  
M.D. Hill
Keyword(s):  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Venous Thrombosis ◽  
Time Trends ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Stroke Type ◽  
Arachnoid Hemorrhage

Background:Stroke incidence has fallen since 1950. Recent trends suggest that stroke incidence may be stabilizing or increasing. We investigated time trends in stroke occurrence and in-hospital morbidity and mortality in the Calgary Health Region.Methods:All patients admitted to hospitals in the Calgary Health Region between 1994 and 2002 with a primary discharge diagnosis code (ICD-9 or ICD-10) of stroke were included. In-hospital strokes were also included. Stroke type, date of admission, age, gender, discharge disposition (died, discharged) and in-hospital complications (pneumonia, pulmonary embolism, deep venous thrombosis) were recorded. Poisson and simple linear regression was used to model time trends of occurrence by stroke type and age-group and to extrapolate future time trends.Results:From 1994 to 2002, 11642 stroke events were observed. Of these, 9879 patients (84.8%) were discharged from hospital, 1763 (15.1%) died in hospital, and 591 (5.1%) developed in-hospital complications from pneumonia, pulmonary embolism or deep venous thrombosis. Both in-hospital mortality and complication rates were highest for hemorrhages. Over the period of study, the rate of stroke admission has remained stable. However, total numbers of stroke admission to hospital have faced a significant increase (p=0.012) due to the combination of increases in intracerebral hemorrhage (p=0.021) and ischemic stroke admissions (p=0.011). Sub-arachnoid hemorrhage rates have declined. In-hospital stroke mortality has experienced an overall decline due to a decrease in deaths from ischemic stroke, intracerebral hemorrhage and sub-arachnoid hemorrhage.Conclusion:Although age-adjusted stroke occurrence rates were stable from 1994 to 2002, this is associated with both a sharp increase in the absolute number of stroke admissions and decline in proportional in-hospital mortality. Further research is needed into changes in stroke severity over time to understand the causes of declining in-hospital stroke mortality rates.

Thrombolysis for Ischemic Stroke in the United States: Data from National Hospital Discharge Survey 1999–2001

Neurosurgery ◽  
2005 ◽  
Vol 57 (4) ◽  
pp. 647-654 ◽  
Author(s):  
Adnan I. Qureshi ◽  
M Fareed K. Suri ◽  
Abu Nasar ◽  
Wei He ◽  
Jawad F. Kirmani ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Hospital Discharge ◽  
The United States ◽  
National Hospital ◽  
National Hospital Discharge Survey ◽  
States Data

Mo1519 In-Hospital Mortality in Alcoholic Cirrhosis - Analysis of the National Hospital Discharge Survey

2016 ◽  
Vol 150 (4) ◽  
pp. S713
Author(s):  
David Mossad ◽  
Ronald J. Markert ◽  
Padmini Krishnamurthy ◽  
Sangeeta Agrawal
Keyword(s):  
Hospital Mortality ◽  
Hospital Discharge ◽  
Alcoholic Cirrhosis ◽  
National Hospital ◽  
National Hospital Discharge Survey

scholarly journals Time Trends in Ischemic Stroke among Type 2 Diabetic and Non-Diabetic Patients: Analysis of the Spanish National Hospital Discharge Data (2003-2012)

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0145535 ◽  
Author(s):  
Nuria Muñoz-Rivas ◽  
Manuel Méndez-Bailón ◽  
Valentín Hernández-Barrera ◽  
José Ma de Miguel-Yanes ◽  
Rodrigo Jiménez-García ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Discharge ◽  
Time Trends ◽  
Hospital Discharge Data ◽  
Diabetic Patients ◽  
National Hospital ◽  
Discharge Data ◽  
Type 2 Diabetic
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