Abstract 19: Prehospital Identification of Acute Ischemic Stroke is Associated With Faster and More Frequent Thrombolysis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Christopher T Richards ◽  
Heidi Sucharew ◽  
Brett M Kissela ◽  
Dawn Kleindorfer ◽  
Kathleen S Alwell ◽  
...  
Keyword(s):  
Large Population ◽  
Geographical Area ◽  
The United States ◽  
Population Based ◽  
Stroke Patients ◽  
Chi Square ◽  
Stroke Study ◽  
Large Geographical Area ◽  
Suspected Stroke ◽  
To Receive

Background: Functional outcomes are improved when AIS patients receive faster treatment. The first medical contact for many AIS patients is with emergency medical services (EMS) providers. We hypothesize that AIS treatment is faster when EMS providers suspect stroke. Methods: We performed a retrospective analysis of the Greater Cincinnati/Northern Kentucky Stroke Study, a comprehensive study of stroke patients in a large geographical area with 1.3 million inhabitants whose demographics are representative of the United States. We compared AIS patients age ≥18 years transported by EMS in 2015 with an EMS impression of “stroke” or “weakness/numbness” to those with other EMS impressions. Primary outcome was thrombolysis rate, and secondary outcomes were times from EMS scene arrival to ED arrival, CT, and treatment and times from ED arrival to CT and treatment. Chi-square and Mann-Whitney U-tests were used to compare treatment rates and times, respectively. Logistic regression (for rates) and median regression (for times) adjusted for NIHSS, GCS, age, sex, race, and prior stroke history. Results: Among 2,486 confirmed AIS patients from 1/1/2015-12/31/2015, 868 were transported by EMS, including 595 (69%) with EMS suspected stroke. Compared to EMS non-suspected strokes, patients with EMS suspected stroke patients were more likely to receive thrombolysis (18% vs 8%; OR 2.67, 95% CI 1.63-4.47) and had faster prehospital transport (30 vs 32 min, p=0.02), ED arrival to CT (27 vs 46 min, p<0.01) and thrombolysis (64 vs 83 min, p=0.03), and EMS scene arrival to thrombolysis (91 vs 118 min, p=0.03) and EVT (164 vs 250 min, p=0.03). Findings were maintained in the adjusted models except for EMS arrival to EVT (Table). Conclusions: In a large population-based study, EMS stroke identification is associated with a higher rate of and faster thrombolysis. Efforts to increase accuracy of EMS stroke identification is likely to have significant clinical impact by shortening treatment times.

scholarly journals Prevalence of systemic lupus erythematosus in Spain: higher than previously reported in other countries?

Rheumatology ◽  
2020 ◽  
Vol 59 (9) ◽  
pp. 2556-2562 ◽  
Author(s):  
Raúl Cortés Verdú ◽  
José M Pego-Reigosa ◽  
Daniel Seoane-Mato ◽  
Mercedes Morcillo Valle ◽  
Deseada Palma Sánchez ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Adult Population ◽  
Geographical Area ◽  
Geographic Origin ◽  
The United States ◽  
Epidemiological Studies ◽  
Population Based ◽  
Cross Sectional Study ◽  
Medical Visit ◽  
Cross Sectional

Abstract Objectives Prevalence of SLE varies among studies, being influenced by study design, geographical area and ethnicity. Data about the prevalence of SLE in Spain are scarce. In the EPISER2016 study, promoted by the Spanish Society of Rheumatology, the prevalence estimate of SLE in the general adult population in Spain has been updated and its association with sociodemographic, anthropometric and lifestyle variables has been explored. Methods Population-based multicentre cross-sectional study, with multistage stratified and cluster random sampling. Participants were contacted by telephone to carry out a questionnaire for the screening of SLE. Investigating rheumatologists evaluated positive results (review of medical records and/or telephone interview, with medical visit if needed) to confirm the diagnosis. To calculate the prevalence and its 95% CI, the sample design was taken into account and weighing was calculated considering age, sex and geographic origin. Multivariate logistic regression models were defined to analyse which sociodemographic, anthropometric and lifestyle variables included in the telephone questionnaire were associated with the presence of SLE. Results 4916 subjects aged 20 years or over were included. 16.52% (812/4916) had a positive screening result for SLE. 12 cases of SLE were detected. The estimated prevalence was 0.21% (95% CI: 0.11, 0.40). SLE was more prevalent in the rural municipalities, with an odds ratio (OR) = 4.041 (95% CI: 1.216, 13.424). Conclusion The estimated prevalence of SLE in Spain is higher than that described in most international epidemiological studies, but lower than that observed in ethnic minorities in the United States or the United Kingdom.

scholarly journals Cutaneous lymphoma incidence patterns in the United States: a population-based study of 3884 cases

Blood ◽  
2009 ◽  
Vol 113 (21) ◽  
pp. 5064-5073 ◽  
Author(s):  
Porcia T. Bradford ◽  
Susan S. Devesa ◽  
William F. Anderson ◽  
Jorge R. Toro
Keyword(s):  
United States ◽  
Large Population ◽  
Survival Rates ◽  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
T Cell Lymphomas ◽  
Cutaneous Lymphomas ◽  
Distinct Disease ◽  
Asian Pacific

Abstract There have been no prior large population-based studies focusing on cutaneous lymphomas (CL) in the United States. Using the Surveillance, Epidemiology and End Results (SEER) program data, we analyzed age-adjusted CL incidence rates (IRs) and survival rates by sex and race/ethnicity. There were 3884 CLs diagnosed during 2001-2005. Cutaneous T-cell lymphomas (CTCLs) accounted for 71% (age-adjusted incidence rate [IR] = 7.7/1 000 000 person-years), whereas cutaneous B-cell lymphomas(CBCLs) accounted for 29% (IR = 3.1/1 000 000 person-years). Males had a statistically significant higher IR of CL than females (14.0 vs 8.2/1 000 000 person-years, respectively; male-female IR ratio [M/F IRR] = 1.72; P < .001). CL IRs were highest among blacks and non-Hispanic whites (both 11.5/1 000 000 person-years), followed by Hispanic whites (7.9) and Asian/Pacific Islanders (7.1). The CTCL IR was highest among blacks (10.0/1 000 000 person-years), whereas the CBCL IR was highest among non-Hispanic whites (3.5). Over the past 25 years, the CL IR increased from 5.0/1 000 000 person-years during 1980-1982 to 14.3 during 2001-2003. During 2004-2005, the CL IR was 12.7. This recent apparent change could be incomplete case ascertainment or potential leveling off of IRs. CLs rates vary markedly by race and sex, supporting the notion that they represent distinct disease entities.

scholarly journals Seroprevalence of SARS-CoV-2 Antibodies Among Homeless People Living Rough, in Shelters and Squats: A Large Population-Based Study in France

2021 ◽  
Author(s):  
Sandrine Loubière ◽  
Elisabetta Monfardini ◽  
Camille Allaria ◽  
Marine Mosnier ◽  
Agathe Allibert ◽  
...  
Keyword(s):  
Large Population ◽  
Large City ◽  
Homeless People ◽  
Population Based ◽  
Homeless Population ◽  
Health Maintenance ◽  
Increased Risk ◽  
Wide Scale ◽  
Sanitary Conditions ◽  
To Receive

Background: Overcrowded housing, as well as inadequate sanitary conditions, contribute to making homeless people particularly vulnerable to the SARS-CoV-2 infection. We aimed to assess the seroprevalence of the SARS-CoV-2 infection among people experiencing homelessness on a large city-wide scale in France, taking into account different community settings. Methods: A consortium of outreach teams in 48 different locations including streets, slums, squats, emergency or transitional shelters and drop-in centres participated in the inclusion process. All participants consented to receive a validated rapid assay for immunoglobulins M (IgM) and G (IgG) antibodies and to answer a questionnaire on medical health conditions, comorbidities, historic of symptoms compatible with COVID-19, with a retrospective calendar of types of accommodation since COVID-19 crisis. Results: From June 01 to August 05, 2020, 1,156 homeless participants were enrolled in the study and tested. Seroprevalence of SARS-CoV-2 IgG/IgM antibodies was 5.6% (95%CI 2.3&ndash;7.0), with a range of 2.2% in people living on the streets to 8.1% in people living in emergency shelters (P=0.009). Around one third of the seropositive participants reported symptoms with COVID-19. Compared to the general population in Marseille (3.6%), the homeless population living in the same urban area experienced an significant increased risk of SARS-CoV-2 infection (|z|=3.65 &gt; 1.96). Conclusion: These results highlight the need for organizing regular screening to prevent clusters forming in homeless accommodations and for providing basic resources for health maintenance.

Abstract W P189: Characteristics of Rural Pre-Hospital Stroke Transports

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Charles Whiteman ◽  
Debra Paulson ◽  
Rosanna Sikora ◽  
Russell Doerr ◽  
Stephen Davis ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Life Support ◽  
The United States ◽  
Rural Setting ◽  
Care Hospital ◽  
Stroke Patients ◽  
Critical Access Hospital ◽  
Suspected Stroke ◽  
Stroke Center ◽  
The Impact

Introduction: West Virginia (WV) is the second most rural state and has a stroke prevalence of 3%. According to the United States Census Bureau, 97.3% of the land is considered rural and 51.3% of the population lives in a rural area. EMS transport times in Northern WV often exceed 20 minutes in rural counties. Little data has been published about EMS response to acute stroke patients in the rural setting. Methods: This was a retrospective cohort study of EMS response and interventions for patients with chief complaint of stroke in the MedCom database providing medical command for 26 northern WV counties. Stroke encounters from January 1, 2002 to December 31, 2011 were analyzed for EMS provider capability, receiving hospital capability, and pre-hospital interventions. Results: There were 7,594 transports available for analysis. Basic Life Support (BLS) responders provided 7.0% of the care. The majority of the patients, 51.6%, were transported to an acute care hospital, 11.6% to a critical access hospital, and 36.9% to a designated stroke center. Blood glucose was determined by glucometer in 66.4% of patients with 2.0% treated for hypoglycemia. Vascular access was attempted in 92.6% of the patients and was successful in 81.5%. Cardiac monitor was applied in 92.4% of the patients and oxygen saturation was determined by pulse oximetry in 95.8%. Oxygen therapy was administered to 96.5% of the patients. Discussion: In rural northern WV, 7% of the suspected stroke patients had care by only a BLS responder. Although evaluation at a designated stroke center has been shown to increase the chance for receiving acute thrombolytic intervention, less than 40% of patients in northern WV were initially seen at a designated stroke center and 11.6% were initially seen at a critical access hospital. Consequently, even critical access hospitals need to be prepared to rapidly evaluate and treat patients with suspected ischemic stroke. Blood glucose was not checked by EMS personnel in more than 30% of all transports. Additional studies are needed to assess the impact of these pre-hospital procedures and transport destination decisions on suspected stroke patient outcomes in the rural setting.

Racial disparities in emergency care for seizures in the United States

2021 ◽  
Vol 13 (9) ◽  
pp. 373-377
Author(s):  
Sriman Gaddam
Keyword(s):  
Relative Risk ◽  
Racial Disparities ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Life Support ◽  
The United States ◽  
Chi Square ◽  
Time Critical ◽  
To Receive ◽  
White Patients

Background: Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure. Aims: This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure. Methods: This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk. Findings: On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients. Conclusions: Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

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