Abstract 82: Patient and Hospital Characteristics of Pregnancy-Related Stroke from the Get With The Guidelines Stroke Registry

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Lisa Leffert ◽  
Caitlin Clancy ◽  
Brian Bateman ◽  
Margueritte Cox ◽  
Phillip Schulte ◽  
...  
Keyword(s):  
Medical History ◽  
Healthcare Setting ◽  
Continuous Variables ◽  
Principal Diagnosis ◽  
Stroke Subtype ◽  
Stroke Registry ◽  
Clinical Detail ◽  
History Of ◽  
Get With The Guidelines ◽  
Hospital Characteristics

Background: Stroke accounts for 14% of maternal deaths. Our knowledge of the risk factors and etiologies of pregnancy-related stroke (PRS) is limited, as most data are derived from small, single center series or large, administrative datasets lacking clinical detail. We sought to describe the patient and hospital characteristics of PRS by analyzing the Get with the Guidelines (GWTG) Stroke Registry. Methods: All female patients aged 18-44 entered into GWTG from 2008-2013 with PRS were ascertained by medical history of pregnancy (i.e. pregnant or <6 weeks postpartum) plus a principal diagnosis ICD-9 code (430, 431) (58%), PRS ICD-9 code (671.5x, 673.04, 674.0x) as the principal diagnosis alone (18%), or with a medical history of pregnancy (24%). Proportions for categorical and medians for continuous variables are reported. Results: We identified 46043 patients with stroke from 1554 sites, of whom 668 (1.5%) had PRS. Ischemic stroke (IS) occurred in 338 (51%), intracerebral hemorrhage (ICH) in 178 (27%) and subarachnoid hemorrhage (SAH) in 152 (23%). Many patient and hospital characteristics differed significantly by stroke subtype (Table). Hypertension, smoking and pre-stroke therapy with antithrombotics or antihypertensives were common; 7.4% of IS were recurrent. About 86% of all strokes did not occur in a healthcare setting and only 27% of patients arrived by EMS. Median initial blood pressure (BP) was higher in HS (ICH and SAH) than in IS, and half of all patients had initial BP below the threshold for pre-eclampsia (140/90 mmHg). HS patients were more often treated at larger, academic hospitals. Conclusions: PRS constituted 1.5% of all strokes aged 18-44 in a large contemporary stroke registry and 50% were HS. Most PRS occurred out of hospital, and half of all cases presented with normal BP levels. Further research is needed to better define PRS etiology.

Abstract W MP99: Race/Ethnic and Sex Differences in EMS Transport among Hospitalized U.S. Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Heidi Mochari-Greenberger ◽  
Ying Xian ◽  
Anne S Hellkamp ◽  
Phillip J Schulte ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Ethnic Group ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
National Sample ◽  
Stroke Patients ◽  
Hispanic Males ◽  
Stroke Registry ◽  
Black Females ◽  
History Of ◽  
Get With The Guidelines

Background: Calling 911 is the recommended first step when stroke symptoms occur. Differences in activation of emergency medical services (EMS) may contribute to race/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS utilization varies among a contemporary, diverse national sample of hospitalized acute stroke patients. Methods: We analyzed data from 398,798 stroke patients admitted to 1,613 Get With The Guidelines-Stroke participating hospitals from 10/1/11-3/31/14. Multivariable logistic regression was utilized to evaluate the associations between race/ethnic group and sex, with EMS use, adjusting for potential confounders. Results: Patients were 50.4% female, 69% white, 19% black, 8% Hispanic, 3% Asian, 1% other; 85.9% ischemic stroke. Overall 58.6% of stroke patients were transported to the hospital by EMS. EMS utilization differed by sex and race/ethnic group (interaction p<0.001). White females were most likely to use EMS (62.0%) and Hispanic males were least likely to (52.2%). Age, health insurance coverage, and history of prior stroke or TIA varied significantly among race/ethnic groups (p<0.0001). After adjustment for both patient and hospital characteristics, Hispanic and Asian men and women were less likely than their white counterparts to utilize EMS; black females were less likely than white females to utilize EMS (Table). Conclusion: EMS use was low overall and differential by race/ethnicity and sex. These contemporary data support a need for targeted initiatives to increase EMS transport among U.S. stroke patients.

Abstract TP175: Migraines and the Risk of Hemorrhagic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Muhammad Umar Farooq ◽  
Kathie Thomas
Keyword(s):  
Ischemic Stroke ◽  
Medical History ◽  
Hemorrhagic Stroke ◽  
The United States ◽  
Future Studies ◽  
History Of ◽  
Medical Histories ◽  
Get With The Guidelines ◽  
The Relationship ◽  
Sample Set

Background and Objectives: Migraine is a common neurological disorder affecting 38 million people in the United States. Hemorrhagic stroke accounts for 13% of all stroke cases and the risk of having a hemorrhagic stroke is 94 in 100,000 or 0.94%. There are two types of hemorrhagic stroke; intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Previous research has investigated the association between migraine and vascular disease, with several studies demonstrating a possible link between migraines and ischemic stroke. The relationship between migraine and hemorrhagic stroke remains unclear. Methods: A retrospective review from January 2012-December 2014 of hemorrhagic stroke patients (n=3682) from 30 Michigan hospitals using a Get With the Guidelines (GWTG) database was conducted. Stroke subtypes and patient medical histories were examined. This sample set was comprised of 46.95% males and 53.05% females. Results: It was found that the risk for hemorrhagic stroke increased from 0.94% to 2.12% with a medical history of migraines. The risk of ICH with a history of migraine in this study was 1.41%, while the risk of SAH with a history of migraine was 3.11%. The median age for a hemorrhagic stroke in this sample set was 67 years. A patient with a medical history that included migraines, had a median hemorrhagic stroke age of 55 years. Of these patients with a history of migraine who developed a hemorrhagic stroke, 74.7% were female and 25.3% were male. Conclusions: This study demonstrated that a higher risk of hemorrhagic stroke is associated with a history of migraines. The median age for an individual with a hemorrhagic stroke and history of migraine was significantly lower (12 years) than the median age of the sample, which indicates that migraines as a risk factor for stroke might be more significant in middle age. Additionally, this risk seemed to impact females much more than males. A limitation of this study is that GWTG Stroke does not include whether the patient has a migraine with or without aura. Migraine with aura has been associated at a higher rate with ischemic stroke than migraine without aura. It would be beneficial for future studies regarding migraine and hemorrhagic stroke to include whether the migraine was associated with or without aura.

scholarly journals Early transition to comfort measures only in acute stroke patients

2017 ◽  
Vol 7 (3) ◽  
pp. 194-204 ◽  
Author(s):  
Shyam Prabhakaran ◽  
Margueritte Cox ◽  
Barbara Lytle ◽  
Phillip J. Schulte ◽  
Ying Xian ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Multivariable Analysis ◽  
Hospital Level ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Factors Associated ◽  
Early Decision ◽  
Stroke Type ◽  
Get With The Guidelines ◽  
Hospital Characteristics

AbstractBackground:Death after acute stroke often occurs after forgoing life-sustaining interventions. We sought to determine the patient and hospital characteristics associated with an early decision to transition to comfort measures only (CMO) after ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in the Get With The Guidelines–Stroke registry.Methods:We identified patients with IS, ICH, or SAH between November 2009 and September 2013 who met study criteria. Early CMO was defined as the withdrawal of life-sustaining treatments and interventions by hospital day 0 or 1. Using multivariable logistic regression, we identified patient and hospital factors associated with an early (by hospital day 0 or 1) CMO order.Results:Among 963,525 patients from 1,675 hospitals, 54,794 (5.6%) had an early CMO order (IS: 3.0%; ICH: 19.4%; SAH: 13.1%). Early CMO use varied widely by hospital (range 0.6%–37.6% overall) and declined over time (from 6.1% in 2009 to 5.4% in 2013; p < 0.001). In multivariable analysis, older age, female sex, white race, Medicaid and self-pay/no insurance, arrival by ambulance, arrival off-hours, baseline nonambulatory status, and stroke type were independently associated with early CMO use (vs no early CMO). The correlation between hospital-level risk-adjusted mortality and the use of early CMO was stronger for SAH (r = 0.52) and ICH (r = 0.50) than AIS (r = 0.15) patients.Conclusions:Early CMO was utilized in about 5% of stroke patients, being more common in ICH and SAH than IS. Early CMO use varies widely between hospitals and is influenced by patient and hospital characteristics.

scholarly journals Cryptogenic stroke

2019 ◽  
Vol 10 (5) ◽  
pp. 396-405
Author(s):  
Shyam Prabhakaran ◽  
Steven R. Messé ◽  
Dawn Kleindorfer ◽  
Eric E. Smith ◽  
Gregg C. Fonarow ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Cryptogenic Stroke ◽  
National Institutes Of Health ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Stroke Etiology ◽  
Discharge Outcomes ◽  
Get With The Guidelines ◽  
Hospital Characteristics

BackgroundNationwide data on patients with cryptogenic stroke (CS) are lacking. We evaluated patient and hospital characteristics, in-hospital treatments, and discharge outcomes among patients with CS compared with other subtypes in the Get With The Guidelines (GWTG)-Stroke registry.MethodsWe identified patients with ischemic stroke (IS) admitted to GWTG-Stroke participating hospitals between January 1, 2016, and September 30, 2017, with documented National Institutes of Health Stroke Scale (NIHSS) scale and stroke etiology (cardioembolic [CE], large artery atherosclerosis [LAA], small vessel occlusion [SVO], other determined etiology [OTH], or CS). Using multivariable logistic regression, we compared hospital treatments and discharge outcomes by subtype, adjusted for patient and hospital characteristics.ResultsAmong 316,623 patients from 1,687 hospitals, there were 63,301 (20.0%) patients with CS. In multivariable analysis, patients with CS received IV thrombolysis more often than other subtypes and had lower mortality than CE, LAA, and OTH but higher mortality than SVO. They were more likely to be discharged home than all other subtypes and be independent at discharge than LAA, OTH, or SVO.ConclusionsIn a large contemporary nationwide registry, CS accounted for 20% of ISs among patients with a documented stroke etiology. Patients with CS had a distinct profile of treatments and outcomes relative to other subtypes. Improved subtype documentation and further research into CS are warranted to improve care and outcomes for patients with stroke.

Abstract T P399: Patient Characteristics and Outcomes in Pregnancy-Related Subarachnoid Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Lisa Leffert ◽  
Caitlin Clancy ◽  
Brian Bateman ◽  
Margueritte Cox ◽  
Phillip Schulte ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Patient Characteristics ◽  
Stroke Onset ◽  
Hospital Death ◽  
Continuous Variables ◽  
Chi Square ◽  
Stroke Registry ◽  
Hospital Deaths ◽  
Get With The Guidelines ◽  
Initial Blood Pressure

Background: Subarachnoid hemorrhage (SAH) accounts for up to 4.1% of all pregnancy-related in-hospital deaths, but is less often aneurysmal and is associated with better short term outcomes than in non-pregnant patients. We sought to describe the risk factors, management and outcomes of pregnant vs. non-pregnant patients with SAH in the Get With The Guidelines (GWTG) Stroke Registry. Methods: Using medical history or ICD-9 codes, we identified 152 pregnant and 5745 non-pregnant SAH female patients aged 18-44 with SAH in GWTG from 2008-2013. Differences in characteristics were compared by Chi-square tests for categorical and Wilcoxon Rank-Sum tests for continuous variables. Stratified logistic regression assessed the effect of pregnancy on outcomes conditional on age and adjusted for patient and hospital characteristics. Results: Pregnant SAH patients were younger, more often black and insured with Medicaid. They had higher initial blood pressure (BP) and were less likely to report prior hypertension. Arrival delays from stroke onset were common in both groups (median 340 vs. 277 min), but pregnant SAH patients were more often already hospitalized at stroke onset (16% vs. 10%). Fewer pregnant vs. non-pregnant SAH patients had initial neurologic exam findings recorded (Table). Pregnant SAH patients had lower in-hospital death than non-pregnant patients (aOR 0.17, 95% CI 0.06-0.45) and were more likely at discharge to ambulate independently (aOR 2.40, 95% CI 1.56-3.69) and return home (aOR 2.60, 95% CI 1.67-4.06). Conclusions: Several differences exist between pregnant and non-pregnant women with SAH. Many present with BP well below the threshold for hypertensive disorders of pregnancy, making prompt recognition and prevention of brain hemorrhage challenging. Overall, pregnancy-related SAH is associated with less morbidity and mortality than non-pregnancy related disease.

How Valid are Patient Reports of Family History of Illness?

1980 ◽  
Vol 19 (03) ◽  
pp. 162-164 ◽  
Author(s):  
Rachel Harris ◽  
W. Margaret ◽  
Kathleen Hunter
Keyword(s):  
Family History ◽  
Medical History ◽  
Cancer Patients ◽  
Cause Of Death ◽  
Death Certificate ◽  
Recall Rate ◽  
Patient Reports ◽  
Small Subgroup ◽  
History Of ◽  
Medical Histories

The recall rate of patients’ family medical histories was studied in 200 cancer and non-cancer patients. Data on age and cause of death for parents and grandparents were collected. Although most patients knew the age and cause of death of parents, less than half knew for grandparents. Cancer patients had significantly greater recall for maternally related relatives. A subsample of patients’ family medical histories was compared to death certificate data. Patients’ reports were found to be highly inaccurate. Since only a small subgroup could provide medical history data for grandparents, the generaliz-ability for history of family illness is questioned.

The Role of HbA1c on Mortality in Patients with Medical History of Ischemic Stroke and Paroxysmal Atrial Fibrillation

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 2406-PUB
Author(s):  
KONSTANTINA KANELLOPOULOU ◽  
IOANNIS L. MATSOUKIS ◽  
ASIMINA GANOTOPOULOU ◽  
THEODORA ATHANASOPOULOU ◽  
CHRYSOULA TRIANTAFILLOPOULOU ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Medical History ◽  
Paroxysmal Atrial Fibrillation ◽  
History Of

The use of a Domain Ontology for the Management of Essential Hypertension (Preprint)

2020 ◽  
Author(s):  
Emma Chavez ◽  
Vanessa Perez ◽  
Angélica Urrutia
Keyword(s):  
Decision Making ◽  
Essential Hypertension ◽  
Medical History ◽  
Medical Records ◽  
Medical Training ◽  
Relevant Information ◽  
Domain Ontology ◽  
Free Text ◽  
Snomed Ct ◽  
History Of

BACKGROUND : Currently, hypertension is one of the diseases with greater risk of mortality in the world. Particularly in Chile, 90% of the population with this disease has idiopathic or essential hypertension. Essential hypertension is characterized by high blood pressure rates and it´s cause is unknown, which means that every patient might requires a different treatment, depending on their history and symptoms. Different data, such as history, symptoms, exams, etc., are generated for each patient suffering from the disease. This data is presented in the patient’s medical record, in no order, making it difficult to search for relevant information. Therefore, there is a need for a common, unified vocabulary of the terms that adequately represent the diseased, making searching within the domain more effective. OBJECTIVE The objective of this study is to develop a domain ontology for essential hypertension , therefore arranging the more significant data within the domain as tool for medical training or to support physicians’ decision making will be provided. METHODS The terms used for the ontology were extracted from the medical history of de-identified medical records, of patients with essential hypertension. The Snomed-CT’ collection of medical terms, and clinical guidelines to control the disease were also used. Methontology was used for the design, classes definition and their hierarchy, as well as relationships between concepts and instances. Three criteria were used to validate the ontology, which also helped to measure its quality. Tests were run with a dataset to verify that the tool was created according to the requirements. RESULTS An ontology of 310 instances classified into 37 classes was developed. From these, 4 super classes and 30 relationships were obtained. In the dataset tests, 100% correct and coherent answers were obtained for quality tests (3). CONCLUSIONS The development of this ontology provides a tool for physicians, specialists, and students, among others, that can be incorporated into clinical systems to support decision making regarding essential hypertension. Nevertheless, more instances should be incorporated into the ontology by carrying out further searched in the medical history or free text sections of the medical records of patients with this disease.

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