Abstract WP302: Racial Differences in Imaging Characteristics and Risk Factors for Primary Intracerebral Hemorrhage: Final Results from the DECIPHER Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Chelsea S Kidwell ◽  
Laura German ◽  
Ravi S Menon ◽  
Nawar Shara ◽  
M. Christopher Gibbons ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Racial Differences ◽  
Demographic Data ◽  
Black Communities ◽  
Imaging Data ◽  
Natural History Study ◽  
Imaging Characteristics ◽  
Primary Hemorrhage ◽  
The Impact

Background: Previous studies have reported racial differences in the incidence, location and risk factors for primary intracerebral hemorrhage (ICH). We now report differences in imaging characteristics and risk factors for ICH from the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) study. Methods: DECIPHER is a longitudinal, multicenter, MRI-based, natural history study of racial differences in primary ICH. Inclusion criteria were: primary ICH, age ≥ 18, baseline and 1 year MRI scan obtained. Clinical and demographic data were collected on all subjects. Results: A total of 193 subjects of black or white race were enrolled. Subject characteristics overall and by race are provided in the table. Black subjects were younger, had a higher rate of hypertension, cocaine use, and were more frequently smokers. White subjects had a higher rate of hyperlipidemia. A lobar ICH location was more frequent in the white subjects, while infratentorial hemorrhages were more common in blacks. 60% of blacks had 1 or more microbleeds compared to 52% of whites (NS), and blacks tended to have more severe white matter disease. Conclusions: In the DECIPHER study, there were significant racial differences both in the risk factors for primary ICH and in the imaging characteristics. Compared to whites, blacks have a greater rate of hypertension, as well as cocaine and tobacco use. Imaging findings are indicative of a more severe underlying small vessel vasculopathy in the black cohort. The risk factor information may be used to enhance prevention programs tailored for black communities at risk of ICH, while imaging data may provide a useful biomarker to assess the impact of these interventions.

Abstract TP358: Prehospital Diagnosis of Intracerebral Hemorrhage in a Mobile Stroke Treatment Unit

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Daniel Vela-Duarte ◽  
Ramnath Santosh Ramanathan ◽  
Atif Zafar ◽  
Ather Taqui ◽  
Stacey Winners ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hematoma Expansion ◽  
Hospital Treatment ◽  
Treatment Team ◽  
Hematoma Volume ◽  
Treatment Unit ◽  
Stroke Treatment ◽  
Imaging Characteristics ◽  
Mobile Stroke Unit ◽  
The Impact

Introduction: The mobile stroke unit (MSTU) is an on-site pre-hospital treatment team that incorporates laboratory and CT scanner and reduces times to treatment for ischemic stroke thrombolysis. The impact of MSTU on treatment and outcomes of intracerebral hemorrhage (ICH) remains unknown. We report our initial experience with ICH encountered on MSTU. Hypothesis: ICH can be quickly identified using MSTU. Hypertension and coagulopathy are common in ICH evaluated on MSTU. Methods: We identified ICH cases from the prospectively collected database encounters. Demographics, clinical features, MSTU imaging and repeat imaging characteristics were reviewed. Initial and follow-up hematoma volume was calculated by the ABC/2 method. Results: Of 295 encounters on MSTU from July 2014 to July 2015, 20 (6.7%) had intracranial hemorrhage, which comprised of 17 intracerebral, 1 subarachnoid and 2 subdural hemorrhages. Median time to CT diagnosis of ICH from emergency medical dispatch was 31 minutes (interquartile range (IQR) 28-36) and that from last known well was 118 minutes (IQR 39-301). Of the 17 ICH patients, 15 (88%) were hypertensive, with a mean systolic blood pressure of 178.1 and diastolic 91.0 mm Hg. Five (29.4%) individuals were found with INR>1.4, 1 of whom received 4-factor prothrombin complex concentrate. Median NIH Stroke Scale was 11 (IQR 7.5-14.5), and median hematoma volume was 10.7 cc (IQR 4.3-30.8). One patient had significant hematoma expansion as defined by >6 cc or 33% relative volume increase. Conclusions: Over 5% of the cases evaluated in the unit presented with ICH, most of whom were hypertensive and had small hematoma volume. MSTU enables early diagnosis of ICH after activation of emergency system, can provide early treatment, and appropriate triage.

Abstract 183: Depressive Symptoms and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Audrey L Austin ◽  
Michael G Crowe ◽  
Martha R Crowther ◽  
Virginia J Howard ◽  
Abraham J Letter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Racial Differences ◽  
Stroke Risk ◽  
Depression Scale ◽  
Stroke Incidence ◽  
Blacks And Whites ◽  
The Impact

Background and Purpose: Research suggests that depression may contribute to stroke risk independent of other known risk factors. Most studies examining the impact of depression on stroke have been conducted with predominantly white cohorts, though blacks are known to have higher stroke incidence than whites. The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke in blacks and whites, and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS), is a national, population-based longitudinal study designed to examine risk factors associated with black-white and regional disparities in stroke incidence. Among 30,239 participants (42% black) accrued from 2003-2007, excluding those lacking follow-up or data on depressive symptoms, 27,557 were stroke-free at baseline. As of the January 2011 data closure, over an average follow-up of 4.6 years, 548 incident stroke cases were verified by study physicians based on medical records review. The association between baseline depressive symptoms (assessed via the Center for Epidemiological Studies Depression scale, 4-item version) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographic factors (age, race, and sex), stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, and history of heart disease), and social factors (education, income, and social network). Results: For the total sample, depressive symptoms were predictive of incident stroke. The association between depressive symptoms and stroke did not differ significantly based on race (Wald X 2 = 2.38, p = .1229). However, race-stratified analyses indicated that the association between depressive symptoms and stroke was stronger among whites and non-significant among blacks. Conclusions: Depressive symptoms were an independent risk factor for incident stroke among a national sample of blacks and whites. These findings suggest that assessment of depressive symptoms may warrant inclusion in stroke risk scales. The potential for a stronger association in whites than blacks requires further study.

Abstract P300: C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: Reasons for Geographic and Racial Differences in Stroke (REGARDS)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Kaitlyn M Peper ◽  
Boyi Guo ◽  
Leann Long ◽  
George Howard ◽  
April P Carson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Racial Differences ◽  
Racial Difference ◽  
Incident Diabetes ◽  
Diabetes Incidence ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Difference ◽  
Adjusted Model ◽  
The Impact

Introduction: Black Americans have a higher incidence of diabetes and have elevated inflammatory biomarkers compared to white Americans. Elevated inflammation is a risk factor for diabetes but the impact of inflammation on the racial disparity in diabetes is unknown. Hypothesis: Elevated C-reactive protein (CRP) attenuates the observed black-white difference in incident diabetes. Methods: REGARDS enrolled 30,239 black and white adults aged ≥45 years from the contiguous US in 2003-07. This analysis included REGARDS participants without baseline diabetes who were assessed for diabetes 9 years later. RRs for incident diabetes by race were calculated using modified Poisson regression adjusting for risk factors known to contribute to the racial difference in diabetes incidence. The attenuation by CRP of the black-white RR of incident diabetes was calculated as the percent difference in the race RR in models with and without CRP adjustment; 95% CI for the difference was estimated using bootstrapping. Results: Of 11,073 participants without baseline diabetes (33% black, 67% white), black participants had higher CRP than white participants, and 12.5% developed incident diabetes. The black-white RR for incident diabetes in the base model was 1.74 (95% CI: 1.52, 1.99) for women and 1.44 (1.25, 1.66) for men. Baseline CRP mediated 21% (14, 29%) of this association in women and 20% (12, 34%) in men. These percent attenuations were similar in models adjusting for other diabetes risk factors but were diminished in a fully adjusted model; 5% (-4, 25%) in women and 7% (-43, 50%) in men (Figure). Conclusion: Adjustment for CRP in base models accounted for 20% and 21% of the excess risk of incident diabetes observed in black men and women, respectively, in this study. This substantial mediation persisted after adjusting for other risk factors but was diminished in the fully adjusted model. This suggests a role of inflammation in the diabetogenic effects of risk factors contributing to the observed racial difference in diabetes incidence.

Unsolicited Patient Complaints among Otolaryngologists

2019 ◽  
Vol 160 (5) ◽  
pp. 810-817 ◽  
Author(s):  
Ashley M. Nassiri ◽  
James W. Pichert ◽  
Henry J. Domenico ◽  
Mitchell B. Galloway ◽  
William O. Cooper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Response Rate ◽  
Demographic Data ◽  
Medical Practices ◽  
Patient Complaints ◽  
Male Sex ◽  
Comparative Feedback ◽  
The Impact ◽  
Over Time

Objectives To analyze unsolicited patient complaints (UPCs) among otolaryngologists, identify risk factors for UPCs, and determine the impact of physician feedback on subsequent UPCs. Methods This retrospective study reviewed UPCs associated with US otolaryngologists from 140 medical practices from 2014 to 2017. A subset of otolaryngologists with high UPCs received peer-comparative feedback and was monitored for changes. Results The study included 29,778 physicians, of whom 548 were otolaryngologists. UPCs described concerns with treatment (45%), communication (19%), accessibility (18%), concern for patients and families (10%), and billing (8%). Twenty-nine (5.3%) otolaryngologists were associated with 848 of 3659 (23.2%) total UPCs. Male sex and graduation from a US medical school were statistically significantly associated with an increased number of UPCs ( P = .0070 and P = .0036, respectively). Twenty-nine otolaryngologists with UPCs at or above the 95th percentile received peer-comparative feedback. The intervention led to an overall decrease in the number of UPCs following intervention ( P = .049). Twenty otolaryngologists (69%) categorized as “responders” reduced the number of complaints an average of 45% in the first 2 years following intervention. Discussion Physician demographic data can be used to identify otolaryngologists with a greater number of UPCs. Most commonly, UPCs expressed concern regarding treatment. Peer-delivered, comparative feedback can be effective in reducing UPCs in high-risk otolaryngologists. Implications for Practice Systematic monitoring and respectful sharing of peer-comparative patient complaint data offers an intervention associated with UPCs and concomitant malpractice risk reduction. Collegial feedback over time increases the response rate, but a small proportion of physicians will require directive interventions.

scholarly journals The impact of risk factor trends on intracerebral hemorrhage incidence over the last two decades—The Tromsø Study

2018 ◽  
Vol 14 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Maria Carlsson ◽  
Tom Wilsgaard ◽  
Stein Harald Johnsen ◽  
Liv-Hege Johnsen ◽  
Maja-Lisa Løchen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Intracerebral Hemorrhage ◽  
Proportional Hazards ◽  
Temporal Trends ◽  
Population Based ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Intracerebral Hemorrhages ◽  
The Impact

Background Studies on the relationship between temporal trends in risk factors and incidence rates of intracerebral hemorrhage are scarce. Aims To analyze temporal trends in risk factors and incidence rates of intracerebral hemorrhage using individual data from a population-based study. Methods We included 28,167 participants of the Tromsø Study enrolled between 1994 and 2008. First-ever intracerebral hemorrhages were registered through 31 December 2013. Hazard ratios (HRs) for intracerebral hemorrhage were analyzed by Cox proportional hazards models, risk factor levels over time by generalized estimating equations, and incidence rate ratios (IRR) by Poisson regression. Results We registered 219 intracerebral hemorrhages. Age, male sex, systolic blood pressure (BP), diastolic BP, and hypertension were associated with intracerebral hemorrhage. Hypertension was more strongly associated with non-lobar intracerebral hemorrhage (HR 5.08, 95% CI 2.86–9.01) than lobar intracerebral hemorrhage (HR 1.91, 95% CI 1.12–3.25). In women, incidence decreased significantly (IRR 0.46, 95% CI 0.23–0.90), driven by a decrease in non-lobar intracerebral hemorrhage. Incidence rates in men remained stable (IRR 1.27, 95% CI 0.69–2.31). BP levels were lower and decreased more steeply in women than in men. The majority with hypertension were untreated, and a high proportion of those treated did not reach treatment goals. Conclusions We observed a significant decrease in intracerebral hemorrhage incidence in women, but not in men. A steeper BP decrease in women may have contributed to the diverging trends. The high proportion of untreated and sub-optimally treated hypertension calls for improved strategies for prevention of intracerebral hemorrhage.

scholarly journals Effects of dietary style on adult enterovirus infection risk factors: a retrospective analysis

2020 ◽  
Author(s):  
Linghua Yu ◽  
Linlin Wang ◽  
Huixing Yi ◽  
Xiaojun Wu ◽  
Fei Sun
Keyword(s):  
Risk Factors ◽  
Gut Microbiota ◽  
Dietary Patterns ◽  
Dietary Pattern ◽  
Clinical Characteristics ◽  
Protective Factor ◽  
Demographic Data ◽  
Adult Patients ◽  
Phone Calls ◽  
The Impact

Abstract Background: Gut microbiota serves as a defense against enteric pathogens, whereas dietary intake influences the composition and function of gut microbiota. We aimed to examine the impact of diet on the enteroviral infection in adult patients of hand, foot, and mouth disease (HFMD). Methods: A total of 266 adult patients of HFMD were recruited in this study, with 80 healthyvolunteers served as the control. Swab samples and clinical characteristics were collected. Enteroviral genotype was further assessed by PCR testing. Social-demographic data and dietary records were obtained through follow-up phone calls. Dietary patterns were derived with PCA analysis. Correlation between dietary patterns and clinical characteristics, enterovirus genotype, and HFMD risk factors were evaluated. Results:Three distinct dietary patterns were identified in the participants, which were modern, "atypical south", and "traditional north", respectively. This study found the dietary pattern of adult HFMD significantly differed from that of the controls. A vast majority of controls followed the modern pattern, which was a healthy diet. In contrast, the result showed unhealthy dietary patterns ('atypical south' and 'traditional north') were risk factors for adult HFMD. Besides, the dining place was a leading contributor to the dietary pattern. Our data showed eating at a food stall, or take-out is a risk factor of adult HFMD, whereas eating at the dining room is a protective factor. Conclusions:Our study indicated dietary pattern was associated with the incidence of adult HMFD. Improving the dietetic habit might contribute to HFMD prevention.

Abstract 3858: Evaluation of Serial Neuroimaging in Patients with Intracerebral Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Tanzila Shams ◽  
Prachi Mehndiratta ◽  
Pichet Termsarasab ◽  
Hesham Masoud ◽  
Siddharth Sehgal ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Intracerebral Hemorrhage ◽  
No Value ◽  
Retrospective Chart Review ◽  
Care Plan ◽  
Hematoma Expansion ◽  
Imaging Studies ◽  
Imaging Characteristics ◽  
Neuroimaging Study ◽  
The Impact

Introduction: The availability of sophisticated neuroimaging has led to increased utilization of imaging studies, particularly at comprehensive stroke centers. This increase in advanced imaging contributes to healthcare costs and has been questioned in this era of reducing reimbursement. Hypothesis: Multiple neuroimaging studies have limited impact in determining the plan of care for most patients with intracerebral hemorrhage. Methods: An IRB-approved retrospective chart review of all patients with Intracerebral Hemorrhage (ICH, ICD 431) treated at UH-CMC in 2010 collected data on demographics, number of neuroimaging studies and imaging characteristics, and the impact of testing on determining a medical or surgical plan of care. Hemorrhage location dictated one of two groups: basal ganglia and thalamus (BG) versus IVH alone, infratentorial and lobar (NBG). Results: Data was available on 120 (86%) of patients; 74 (62%) were male. Mean volume of ICH on initial CT was significantly smaller at 8.5±11.7cc in 41 BG patients vs 63±27cc in 79 NBG patients (p=0.01). The decision to pursue surgical treatment (extraventricular drainage in 14, craniotomy in 9, or both in 4) was determined prior to a third neuroimaging study. Three or more neuroimaging studies were obtained in 56% of BG and 59% of NBG patients. Hematoma expansion was less likely to occur in BG vs NBG patients, both for significant hematoma expansion (>33% or +12.5cc increase, 5% vs 22%, p=0.05) and nonsignificant hematoma expansion (10-33% increase, 2.4% vs 8.9%, p=0.27). Hematoma expansion was exclusively within the first 2 imaging studies for BG patients but occurred in a delayed fashion in 3 (4%) of NBG patients. MRI was obtained in 17% of BG and 44% of NBG patients; only in 3 of the NBG patients did it identify a vascular malformation which led to surgery in 1 patient. Conclusion: Although more than half of patients with intracerebral hemorrhage underwent three or more neuroimaging studies, 95% of patients’ care plan decisions were determined by the first, and to a lesser extent, the second neuroimaging study. Serial neuroimaging after the second study was of no value in patients with small basal ganglia hemorrhages and impacted the care plan in less than 10% of patients with hemorrhages in alternate locations. Our data suggests many neuroimaging studies can be safely omitted.

scholarly journals Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI

Vaccines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 36
Author(s):  
Abram L. Wagner ◽  
Lydia Wileden ◽  
Trina R. Shanks ◽  
Susan Door Goold ◽  
Jeffrey D. Morenoff ◽  
...  
Keyword(s):  
Racial Differences ◽  
Race And Ethnicity ◽  
Healthcare Providers ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Black Communities ◽  
Vaccination Acceptance ◽  
Black Residents ◽  
Trust In Healthcare Providers ◽  
The Impact

Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals’ personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.

scholarly journals IL-33 as a Novel Serum Prognostic Marker of Intracerebral Hemorrhage

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ye Miao ◽  
Zhen-xing Zhang ◽  
Xu Feng ◽  
Wei-ming Sun
Keyword(s):  
Intracerebral Hemorrhage ◽  
Poor Prognosis ◽  
Demographic Data ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Underlying Mechanism ◽  
Good Prognosis ◽  
Imaging Data ◽  
Hematoma Volume ◽  
Number Of Patients

Objective. Interleukin 33 (IL-33) is a key cytokine involved in inflammation and oxidative stress. The significance of serum IL-33 levels on the prognosis of patients with intracerebral hemorrhage (ICH) has not been well studied. The purpose of this study is to determine whether there is a relationship between the serum IL-33 level and the prognosis of patients with ICH upon admission. Methods. A total of 402 patients with confirmed ICH were included in this study. Their demographic data, medical history, laboratory data, imaging data, and clinical scores on admission were collected. At the same time, enzyme-linked immunoassay (ELISA) was used to detect the serum IL-33 levels of patients. The prognosis of patients was evaluated by mRS scale after 3 months, and mRS > 2 was defined as poor prognosis. Results. Among 402 patients with ICH, the number of patients with good prognosis and poor prognosis after 3 months was 148 and 254, respectively. Compared with the ICH group with poor prognosis, the ICH group with good prognosis had lower baseline NHISS scores ( p = 0.039 ) and hematoma volume ( p = 0.025 ) and higher GCS scores ( p < 0.001 ) and serum IL-33 levels ( p < 0.001 ). The results of linear correlation analysis showed that serum IL-33 levels were significantly negatively correlated with baseline NHISS scores ( r = − 0.224 , p = 0.033 ) and hematoma volume ( r = − 0.253 , p = 0.046 ) but were significantly positively correlated with baseline GCS scores ( r = 0.296 , p = 0.020 ). The receiver operating characteristic curve (ROC) analysis showed that the sensitivity and specificity of serum IL-33 level in evaluating the prognosis of ICH were 72.1% and 74.3%, respectively. A cut-off value of serum IL-33 level < 109.3  pg/mL may indicate a poor prognosis for ICH. Conclusions. Serum IL-33 level on admission may be a prognostic indicator of ICH, and its underlying mechanism needs further study.

Abstract P320: Impact of Inpatient TEE on Secondary Stroke Prevention

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Elan Miller ◽  
Franziska Herpich ◽  
Olivia Gruder ◽  
Priyadarshee Patel
Keyword(s):  
Risk Factors ◽  
Demographic Data ◽  
Tertiary Care ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Stroke Management ◽  
Exact Test ◽  
Factors Associated ◽  
New Findings ◽  
The Impact

Introduction: Transthoracic echocardiogram (TTE) is part of the standard stroke workup. If stroke remains cryptogenic after TTE and rest of the initial stroke evaluation, a transesophageal echocardiogram (TEE) is often performed. Evidence about when and in whom TEE should be done is lacking and reported effect on management vary widely. Our goal was to investigate the impact of TEE on stroke management. Methods: We performed a retrospective study of patients admitted with acute ischemic stroke (AIS) between April 2017 and December 2019 to a single, tertiary care, academic center. All patients received TTE and TEE while inpatient. Demographic data, clinical characteristics, results of echocardiograms and discharge medications were collected via chart review. Primary endpoint was change in stroke management based on TEE results. Secondary endpoint discovery of potential stroke etiology and factors associated with TEE results leading to change in management including age, multi-territory infarcts, TTE and vascular risk factors. We used Fisher’s Exact test and 2-sided Wilcoxon-Mann-Whitney rank-sum test. Results: We analyzed 92 patients with AIS who received both TTE and TEE. Median age was 56 (range 23-88), 51% were male and median NIHSS on admission was 9 (0-30). Middle cerebral artery infarct occurred in 58% and 32% had infarcts in multiple territories. Median hospital stay was 9 days (2-43). TEE revealed findings not seen on TTE in 52% and changed management in 16.3% of cases. Surprisingly, It appeared that older age was more likely to be associated with change of management based of TEE results (median age 61 vs. 55), as were multi-territory infarcts (46.7% vs 28.6%). However, neither of these results were statistically significant. Normal TTE findings were similar in both groups (60.0% vs 57.1%) and no vascular risk factors were associated with change of management based on TEE. Conclusion: TEE changes secondary stroke management in approximately one-sixth of patients and revealed new findings in about half. A larger study is needed to find factors associated with change in management based on TEE results.

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