Abstract 3572: Clinical Outcomes of the “Stroke100 Club”

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amy K Guzik ◽  
Rema Raman ◽  
Kain Ernstrom ◽  
Dawn M Meyer ◽  
Ajeet Sodhi ◽  
...  
Keyword(s):  
Regression Models ◽  
Young Patients ◽  
Older Age ◽  
Advanced Age ◽  
Stroke Severity ◽  
Old Patients ◽  
Multivariable Regression ◽  
Independent Variable ◽  
Poor Outcomes ◽  
Multivariable Regression Models

Background: Patients with advanced age or high NIHSS have poorer tPA outcomes. When combined, old age (≥80yo) and elevated NIHSS (≥20) may have an even worse outcome. Patients who are also in this “Stroke100 Club” (any combination of age and NIHSS ≥100) by other means, have not been fully assessed. We evaluated discharge destination, 90-day mRS, sICH and death in treated and untreated Stroke100 Club patients. We further compared patients with age ≥ 80 and NIHSS ≥ 20 (“80/20s”), those who reached 100 without both characteristics (“non80/20s”) and ‘controls’. Methods: The UCSD SPOTRIAS prospectively collected database was analyzed for AIS patients (with and without tPA). Multivariable regression models including the Stroke100 group as an independent variable was used. Outcomes were adjusted for baseline mRS. For comparing categorical outcomes between controls, “80/20s” and “non80/20s” subgroups, a Fisher’s exact was used. Results: The IV tPA subset included 257 patients (mean age 71, 52% male, 85% white, mean NIHSS 12). 53 were in the “Stroke100 Club” (28 80/20, 25 non80/20), with more women (68% p= 0.002), higher NIHSS (22.5 p<0.0001), older age (mean age 86.4 p<0.0001), higher pre stroke mRS (34.6% mRS 3-6 vs 7.84%, p<0.0001), more HTN (p=0.045) and more afib (p= 0.008). There were 284 non tPA patients (mean age 69.52, 54% male, 85% white, mean NIHSS 5.92). 21 were in the “Stroke100 Club” (14 80/20, 7 non80/20), with higher NIHSS (23 p<0.0001), older age (mean 86.2 p<0.0001), higher pre stroke mRS (45.5% 3-6 vs 9.5%, p= 0.0001), and more afib (p= 0.0002). Stroke100 Club 90day mRS(3-6) outcomes were worse in both tPA treated patients (OR=6.77, p= 0.0001) and nontreated patients (OR 31.57, p= 0.001). sICH rates (in tPA subjects) were not different (3.8% vs 3.4%, p> 0.99). Conclusions: There is a question of treatment outcome in patients with various permutations of stroke severity and advanced age. Our data corroborates the concern of poor outcomes for Stroke100 Club patients, but notes no increased sICH with tPA. Though outcome may be poor, withholding tPA should be discouraged as worse outcomes were not due to sICH. Young patients with severe strokes or old patients with mild strokes may have outcomes similar to the standard “80/20” Stroke100 patients, however further adjusted analysis is ongoing. In addition, further analyses are being done to compare tPA to non tPA patients.

Abstract WP59: IV rt-PA Treatment Response of The STROKE100 Club: Sy stematic Te chnique for Ri sk and Ou tcome Measurements Using Key El ements Totaling 100.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Amy K Guzik ◽  
Rema Raman ◽  
Karin Ernstrom ◽  
Dawn M Meyer ◽  
Thomas Hemmen ◽  
...  
Keyword(s):  
Treatment Response ◽  
Advanced Age ◽  
Prior History ◽  
Stroke Severity ◽  
Poor Outcome ◽  
History Of ◽  
Multivariable Regression ◽  
Independent Variable ◽  
Multivariable Regression Models ◽  
Iv Tpa

Background: Advanced age and high NIHSS are independent predictors of poor AIS outcome. While not excluded from IV rtPA, response is debated in these groups. Patients in the “STROKE 100 Club” (AIS with any combination of age + NIHSS ≥100) have worse outcome without increased sICH. Treatment response has not been evaluated. We evaluated 90 day outcome in the “STROKE 100 Club” with or without rt-PA. Methods: The UCSD SPOTRIAS prospectively collected database was analyzed for “STROKE 100 Club” patients, and all AIS patients either ≥ 80 years old or with NIHSS ≥ 20. Multivariable regression models were used with treatment group as independent variable. Models were adjusted for pre-specified covariates: pre-stroke mRS, diabetes, and atrial fibrillation. Results: We identified 82 STROKE 100 Club patients; 24 were untreated, 58 received IV rtPA. IV tPA treated patients were less likely to have prior history of stroke (22.8% vs 54.2%, p=0.0089). No treatment difference was seen in discharge destination, death, or poor outcome (mRS 3-6) at 90 days. In patients either ≥ 80 years old or with NIHSS ≥ 20, no difference was seen in 90 day outcomes between IV tPA and untreated patients, controlling for baseline variables. In patients ≥ 80 years old, poor outcome was associated with higher NIHSS (OR 1.16, 95% CI 1.09-1.24, p<0.0001) and mRS 3-6 (OR 5.28, 95% CI 1.64-16.96, p=0.0052). Higher NIHSS was also associated with death (OR 1.11, 95% CI 1.06-1.16, p<0.0001) and discharge to facility (OR 1.17 95% CI 1.10-1.24, p<0.0001). Conclusions: Prognosis remains a concern in patients with various permutations of stroke severity and advanced age. Patients ≥80 with higher NIHSS had worse outcome, confirming our prior findings in the STROKE 100 club. Interestingly, IV tPA in the STROKE 100 Club did not lead to worse outcome. IV rtPA remains a safe treatment option for patients in the STROKE 100 club. Ongoing analyses may identify subgroups at greater or lesser benefit of thrombolysis. Planned analyses include assessment in a larger NIH-SPOTRIAS cohort.

Abstract 16: EARLY: EMS Prenotification Augments Stroke Code Timepoints But Rigorous Training is Needed for Larger Yield in stroke.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Amy K Guzik ◽  
Rema Raman ◽  
Karin Ernstrom ◽  
Dawn M Meyer ◽  
Thomas Hemmen ◽  
...  
Keyword(s):  
Regression Models ◽  
Treatment Rate ◽  
Accurate Identification ◽  
Stroke Team ◽  
Stroke Diagnosis ◽  
Multivariable Regression ◽  
Independent Variable ◽  
Baseline Characteristics ◽  
Multivariable Regression Models ◽  
Baseline Covariates

Background: rtPA for AIS is time sensitive, requiring efficient and coordinated acute care. We evaluated time to evaluation, stroke diagnosis, treatment rate, and 90 day outcome in patients with stroke team prenotification by EMS and those identified after arrival. Methods: The UCSD SPOTRIAS prospectively collected database was analyzed for patients with stroke team prenotification by EMS and other patients seen in stroke code, excluding inpatient codes. Multivariable regression models used outcome of interest as independent variable. Models were adjusted for pre-specified covariates: pre-stroke mRS, age, gender, smoking, baseline NIHSS and glucose. Time differences between groups were analyzed using Wilcoxon Rank Sum Tests. Results: We assessed 2867 patients, with EMS prenotification in 643 (22.4%). Assessment at 90 days was obtained in 216 with prenotification and 807 others. Those with prenotification were older (mean 68 vs 66, p=0.0498), with higher pre-stroke mRS (p=0.0243), NIHSS (10.9 vs 8.5, p< 0.0001) and glucose (139 vs 135, p=0.0013). Prenotification led to shorter time to imaging, decision, and IV rtPA treatment (all p<0.0001). No difference was seen in IV rtPA treatment rate (18% EMS prenotifications vs 16% others). When controlling for baseline characteristics, stroke was diagnosed more frequently in patients without EMS prenotification (OR 1.31, 95% CI 1.08-1.58, p=0.0057). Poor outcome (mRS 3-6) was seen more frequently in prenotification patients (45.83% vs 35.32%, p=0.006, NS after adjusting for baseline covariates). Conclusions: In the UCSD experience, EMS prenotification leads to faster evaluation critical in stroke. Prenotification occurred in patients at a medically worse baseline, but did not result in higher rates of final stroke diagnosis or IV rtPA. With improved education, accurate identification of AIS patients may improve, further expediting care and improving treatment and outcomes.

scholarly journals The Impact of Weather and Seasons on Falls and Physical Activity among Older Adults with Glaucoma: A Longitudinal Prospective Cohort Study

Sensors ◽  
2021 ◽  
Vol 21 (10) ◽  
pp. 3415
Author(s):  
Hursuong Vongsachang ◽  
Aleksandra Mihailovic ◽  
Jian-Yu E ◽  
David S. Friedman ◽  
Sheila K. West ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Fall Prevention ◽  
Regression Models ◽  
Activity Promotion ◽  
Injurious Fall ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
The Impact ◽  
The Relationship

Understanding periods of the year associated with higher risk for falling and less physical activity may guide fall prevention and activity promotion for older adults. We examined the relationship between weather and seasons on falls and physical activity in a three-year cohort of older adults with glaucoma. Participants recorded falls information via monthly calendars and participated in four one-week accelerometer trials (baseline and per study year). Across 240 participants, there were 406 falls recorded over 7569 person-months, of which 163 were injurious (40%). In separate multivariable regression models incorporating generalized estimating equations, temperature, precipitation, and seasons were not significantly associated with the odds of falling, average daily steps, or average daily active minutes. However, every 10 °C increase in average daily temperature was associated with 24% higher odds of a fall being injurious, as opposed to non-injurious (p = 0.04). The odds of an injurious fall occurring outdoors, as opposed to indoors, were greater with higher average temperatures (OR per 10 °C = 1.46, p = 0.03) and with the summer season (OR = 2.69 vs. winter, p = 0.03). Falls and physical activity should be understood as year-round issues for older adults, although the likelihood of injury and the location of fall-related injuries may change with warmer season and temperatures.

Preadmission Corticosteroid Therapy and the Risk of Respiratory Failure in Adults Without HIV Presenting With Pneumocystis Pneumonia

2019 ◽  
Vol 35 (12) ◽  
pp. 1465-1470 ◽  
Author(s):  
Patrick M. Wieruszewski ◽  
Erin F. Barreto ◽  
Jason N. Barreto ◽  
Hemang Yadav ◽  
Pritish K. Tosh ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Corticosteroid Therapy ◽  
Regression Models ◽  
Pneumocystis Pneumonia ◽  
Severe Respiratory Failure ◽  
Corticosteroid Administration ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
Reduced Risk ◽  
Hiv Negative

Background: Corticosteroid therapy is a well-recognized risk factor for Pneumocystis pneumonia (PCP); however, it has also been proposed as an adjunct to decrease inflammation and respiratory failure. Objective: To determine the association between preadmission corticosteroid use and risk of moderate-to-severe respiratory failure at the time of PCP presentation. Methods: This retrospective cohort study evaluated HIV-negative immunosuppressed adults diagnosed with PCP at Mayo Clinic from 2006 to 2016. Multivariable regression models were used to evaluate the association between preadmission corticosteroid exposure and moderate-to-severe respiratory failure at presentation. Results: Of the 323 patients included, 174 (54%) used preadmission corticosteroids with a median daily dosage of 20 (interquartile range: 10-40) mg of prednisone or equivalent. After adjustment for baseline demographics, preadmission corticosteroid therapy did not decrease respiratory failure at the time of PCP presentation (odds ratio: 1.23, 95% confidence interval: 0.73-2.09, P = .38). Additionally, after adjusting for inpatient corticosteroid administration, preadmission corticosteroid use did not impact the need for intensive care unit admission ( P = .98), mechanical ventilation ( P = .92), or 30-day mortality ( P = .11). Conclusions: Corticosteroid exposure before PCP presentation in immunosuppressed HIV-negative adults was not associated with a reduced risk of moderate-to-severe respiratory failure.

Component-resolved diagnosis and beyond: Multivariable regression models to predict severity of hazelnut allergy

Allergy ◽  
2017 ◽  
Vol 73 (3) ◽  
pp. 549-559 ◽  
Author(s):  
M. R. Datema ◽  
R. van Ree ◽  
R. Asero ◽  
L. Barreales ◽  
S. Belohlavkova ◽  
...  
Keyword(s):  
Regression Models ◽  
Component Resolved Diagnosis ◽  
Multivariable Regression ◽  
Multivariable Regression Models

scholarly journals Describing and Presenting Multivariable Regression Models

2020 ◽  
Vol 30 (4) ◽  
pp. 303-305
Author(s):  
Dmitry Tumin ◽  
Mary Hayney ◽  
Rebecca P Winsett
Keyword(s):  
Regression Models ◽  
Multivariable Regression ◽  
Multivariable Regression Models

Confidence interval reporting for measures of association in multivariable regression models in observational studies

2019 ◽  
Vol 153 (6) ◽  
pp. 239-242
Author(s):  
Adrián González-Marrón ◽  
Jordi Real ◽  
Carles Forné ◽  
Albert Roso-Llorach ◽  
Eva María Navarrete-Muñoz ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Observational Studies ◽  
Regression Models ◽  
Measures Of Association ◽  
Multivariable Regression ◽  
Multivariable Regression Models

scholarly journals Influence of Age on Thrombolysis Outcome in Wake-Up Stroke

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2898-2900 ◽  
Author(s):  
Dulka Manawadu ◽  
Shankaranand Bodla ◽  
Jeff Keep ◽  
Lalit Kalra
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Reference Group ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Old Patients ◽  
Baseline Characteristics ◽  
Poor Outcomes ◽  
Better Than

Background and Purpose— Thrombolysis in patients >80 years remains controversial; we hypothesized that >80-year-old patients with wake-up ischemic stroke (WUIS) will benefit from thrombolysis despite risks because of poor outcomes with no treatment. Methods— The study included 68 thrombolysed patients with WUIS (33 [48%] >80 years), 54 nonthrombolysed patients with WUIS (21 [39%] >80 years), and 117 patients (>80 years old) thrombolysed within 4.5 hours of symptom onset (reference group). Mortality and modified Rankin Scale (mRS) were assessed at 90 days. Results— Baseline characteristics of thrombolysed and nonthrombolysed >80 and ≤80-year-old patients with WUIS were comparable. Thrombolysis outcomes in >80-year-old patients with WUIS were better than in nonthrombolysed >80-year-old patients with WUIS (90-day mortality: 24% versus 47%, P =0.034; mRS 0–2: 30% versus 5%, P =0.023; mRS 0–1: 15% versus 5%, P =0.24) and comparable with thrombolysed ≤80-year-old patients with WUIS. Thrombolysis was associated with odds ratio 0.27 (95% confidence interval, 0.05–0.97) for mortality and odds ratio 28.6 (95% confidence interval, 1.8–448) for mRS 0 to 2 at 90 days in >80-year-old patients with WUIS after adjusting for stroke severity and risk factors. Conclusions— Thrombolysis may be associated with greater benefit in >80-year-old patients with WUIS but a selection bias favoring thrombolysis in those most likely to benefit may significantly reduce interpretability of these findings.

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